HSE board meeting minutes 27 January 2023

A meeting of the Board of the Health Service Executive was held on Friday 27 January 2023 at 9:00am via video conference.

Present:

Mr Ciarán Devane (Chairperson), Prof Deirdre Madden, Ms Anne Carrigy, Mr Brendan Lenihan, Mr Brendan Whelan, Mr Aogán Ó Fearghaíl, Mr Fergus Finlay, Dr Sarah McLoughlin, Prof Fergus O’Kelly, Mr Tim Hynes, Dr Yvonne Traynor and Ms Michelle O’Sullivan

In Attendance for Board Meeting:

Mr Stephen Mulvany (Interim CEO), Mr Damien McCallion (COO), Mr Dean Sullivan (CSO), Ms Mairead Dolan (Interim CFO), Dr Colm Henry (CCO), Ms Anne Marie Hoey, ND HR, Mr Mark Brennock (ND Communications), Mr Joseph Duggan (ND IA), Ms Eileen Whelan (ND T&T), Mr Brian Murphy (Head of Corporate Affairs), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Office of the Board).

Joined the meeting:

Mr Patrick Lynch (ND Governance & Risk)(Item 3), Dr Philip Crowley (ND Strategy & Research) and Ms Miin Alikan (AND)(Item 4)

Minutes reflect the order in which items were considered and are numbered in accordance with the original agenda.

1.1 Board Members Private Discussion

The Chairperson welcomed Board members and held a private session to consider the agenda and papers for the meeting.

The Chair noted that a paper setting out the principal elements of the terms and conditions (including term, remuneration and other material provisions) from the CEO employment contract had been circulated by email and approved by the Board as required by Section 10 of the Health Service executive (Governance) Act 2019. Decision No: 270123/01

1.2 Declarations of Interest

No conflicts of interest were declared.

1.3 Chairperson’s Remarks

The Chairperson provided an update to the Board during their private session.

1.4 Correspondence

The following correspondence was noted and the Chair advised that it would be referred to later in the meeting.

Ministerial Correspondence

• 2022 Revised Approved Level of Net Expenditure dated 23 December 2022

Correspondence

• Letters from former HSE staff re Report 42 – Pay Scales affecting Senior Manager dated 20 Dec 2022 & 16 Jan 2023
• Letter re Owenacurra dated 06 January 2023
• Letter from Chair Mental Health Commission re Independent Review of the provision of CAMHS dated 05 January 2023 & CEO HSE response dated 16 January 2023

1.5 Minutes of Board meeting

The Board approved the minutes of 16 December 2022. Feedback was provided regarding the minutes from the 13 January 2023 Winter Pressures Board meeting. The feedback will be incorporated into the minutes and a draft will be brought to the February Board meeting for approval.

2.1 Audit and Risk Committee

The Audit and Risk Chair informed the Board that the Audit and Risk Committee did not meet in January, with a view to facilitating the annual financial reporting cycle. The next meeting will take place on 10 February 2023.

The Chairperson welcomed and introduced Mr Joseph Duggan, National Director of Internal Audit to the meeting, and wished him well in his new position.

2.2 People & Culture Committee

The minutes of the Committee meeting of 02 December 2022 and HR Dashboard were noted.

The People and Culture Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 13 January 2023. The Board were informed that the Committee received an update on the RHA programme. She advised that the plan to complete the recruitment of the CEOs for the six RHAs, and as far as possible the associated top teams, with the CEO position be advertised early in Q2 2023 to achieve the go live of the RHA’s on 1st January 2024.

The Committee were provided with an update on the Non-Consultant Hospital Doctor (NCHDs) agreement which will see improvements for NCHDs supports. The new public only Hospital Consultant Contract negotiations have concluded, with the implementation date of the new contract expected to take place in February. HR will engage with each hospital consultant to encourage the uptake of the new contract.

The Committee Chair advised that 99% of statutory and Section 38 staff have received the Special Pandemic Recognition payment, and that a contract for additional support to progress payments to non HSE / Section 38 employees has also been awarded.

An update was given to the Committee with regard to the increase to the year to date staffing level, with 2022 being the highest year to date for recruitment. The Committee requested that more emphasis is required on the recruitment of homecare posts. The Committee will continue to monitor this through the HR Heatmap.

The Committee reviewed the data presented in relation to mandatory training and agreed that the data should show the percentage of training conducted in CHOs and Hospitals separately for an accurate picture of compliance.

The Committee were provided with the draft Interim Resourcing Strategy which outlines a programme of work under 5 main pillars - engagement and retention of our workforce, attracting high performing and diverse talent, building healthcare talent for the future, supporting the health and wellbeing of our workforce, and building a positive and inclusive workplace culture. The draft was welcomed by the Committee.

The Committee Chair advised that the Committee will review the first draft report of the HSE Accountability Framework at their next meeting in March.

2.3 Performance and Delivery Committee

The minutes of the Committee meeting of 09 December 2022 were noted and the Performance and Delivery Chair provided a verbal report on the matters considered at the Committee meeting that took place on 25 January 2023.

The Committee reviewed the Operational Services Report (November Data), Performance Profile (November Data), Draft National Performance Oversight Group Meeting Notes (November Data) and the PMO Report – Winter/National Service Plan (NSP) 2022-23. Scheduled Care, Unscheduled Care and the service pressures during the winter period were also discussed.

The Committee Chair advised the Board that the Committee strongly supports the Executive’s proposal to produce a medium term (3 year) plan for unscheduled care. This plan will be informed by the capacity review being progressed by the HSE and the Department of Health (DoH), and find a way of aligning the review with the development of the Regional Health Areas (RHAs) and the urgent implementation of Sláintecare. The Committee asked the Board to make it a standing item on the Board Agenda. The Board were informed that the Integrated Care Programme for Older Persons (ICPOP) is to be further developed and that a deep dive into ICPOP will take place at a future Performance and Delivery Committee meeting. The Board were also informed that work remains ongoing in relation to Progressing the Disability Services Roadmap.

The Committee Chair advised that discussions took place in relation to the insufficient number of health and social care professionals that are graduating from Irish colleges and universities, and how this does not reflect the level of demand in the service. The People and Culture Committee Chair advised that this is being reviewed through the Resourcing Strategy by the People & Culture Committee.

The Committee Chair advised of the appointment of Ms Joan Johnstown to the Performance and Delivery Committee for a period of 3 years. This was approved by the Board. Decision No: 270123/02

2.4 Safety & Quality Committee

The minutes of the Committee meeting of 13 December 2022 and the January 2023 Quality Profile were noted. The Safety and Quality Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 20 January 2023.

The Committee heard from the CCO regarding his report. The report included information regarding winter viruses, unscheduled care, the vaccination programme and the National Cancer Care Programme (NCCP).

The Committee was also given an update on the National Screening Service (NSS) Strategic Plan 2023- 2027. Regarding Interval Cancer, the Committee Chair gave an overview of the Patient Requested Review Process that is due to commence shortly, including its benefits and risks. The Legal Framework Group (LFG) interim report that was provided to the Committee outlined twelve recommendations regarding NSS, four of which recommended actions from the EMT/Board. Following discussion of these recommendations, it was agreed that the CEO will follow up with appropriate correspondence citing the support of the Board where relevant.

The Committee Chair provided an overview of the Mental Health Commission Interim Report on CAMHS which was brought to the Committee, as well as the management response to the issues raised. She noted the serious concerns expressed by the Committee in relation to these issues and informed the Board that the Committee will keep this matter on its agenda and require updates on the implementation of recommendations from the report at regular intervals.

2.5 Technology and Transformation Committee

The minutes of the Committee meeting of 17 October 2022, Special meeting re ICT Capital Plan on 03 November 2022 and Workshop of 28 November 2022 were noted. The Technology and Transformation Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 19 January 2023.

The Committee Chair advised that the meeting focused on reviewing the ICT Capital Plan. The Committee received an update on eHealth and ICT funding and were presented with a paper on the HSE IT Budget Benchmark. The Committee also discussed the policy surrounding the implementation of eHealth programmes and emphasised the importance of ensuring clinicians are involved in the development of these policies. The Committee Chair noted that the Committee is to undertake an information and education session cyber to ensure that they are proficient in the topic. He proposes bringing this to the Board also.

It was agreed that the Terms of reference of the Committee would be updated to provide that they will oversee the creation of a Transformation Roadmap to provide clarity to the Board that allows more effective oversight. It will also create and operate a reporting mechanism that allows the Board to understand what progress is being made against this roadmap. This should highlight the interdependencies (policy, people, structure, funding, technology, etc.) that must be taken into account to avoid a silo approach to Transformation.

Due to the absence of the Chair, Prof D. Madden Deputy Chairperson took the Chair for the CEO Report

The CEO welcomed Mr Joseph Duggan who commenced as HSE National Director of Internal Audit on the 16th January 2023. Sincere thanks were noted to Tom Malone for providing excellent stewardship of the Internal Audit function over the past number of months.

The Board noted the CEO’s monthly report and supporting documents which had been circulated prior to the meeting. The Board reviewed and discussed the following strategic areas of the report with management.

Unscheduled Care Pressures

The CEO provided an update on the management response to the winter challenges and outlined the impact of additional actions and initiatives funded through the Winter Plan. He reported there has been a significant downward trend in notifications and hospitalisations and that the escalation actions and winter plan supports, have resulted in sustained improvements in several Key Performance Indicators (KPIs) over the last four weeks.

The Board welcomed the improvements, but acknowledged that some patients are still experiencing unacceptable delays for admission and there are continued risks in terms of unscheduled care pressures. The Board discussed and agreed the need to plan and deliver incremental and sustained performance improvement across all sites in relation to unscheduled care to improve patient and staff experience. A key element of this future planning will be the development of a multi-annual unscheduled care improvement programme.

The CEO confirmed that HSE management continue to meet and engage regularly with the Minister for Health and DoH officials on the ED situation to problem solve to inform immediate actions, future learnings and a medium term (3 year) plan.

The CEO informed the Board that he is beginning a process of engagement with the senior leaders around the long term elimination of winter pressures which will require the adoption of a formal management method that puts patient safety first and eliminates waste in all its forms, including waste of patient / service user time and skills. He said that he would be grateful for Board input in due course.

Re-designation of certain voluntary service providers from Section 39s to 38s status

The CEO informed the Board that the Minister has announced approval for the re-designation of four hospice organisations from Section 39 service level agreements with the HSE to Section 38 agreements. The Board discussed the pay equality issues in Section 39 providers affecting on their ability to recruit and retain staff and by extension to provide additional service capacity. It was noted that they are seeing staff leave for positions in the HSE and Section 38s, impacting on their service users. This is leading to an increased reliance on the expensive for-profit service providers. The Board welcomed this noting that the re-designation will provide a sustainable model of care for adult specialist palliative care services in Ireland and ensure the provision of these core services going forward. The Board noted that this issue has been referred to the Workplace Relations Commission and the HSE will be attending.

Child and Adolescent Mental Health Services (CAMHS)

The Board considered the issues arising in CAMHS, on foot of the Interim Report to the HSE submitted by the Inspector of Mental Health Services. Arising from the review, the Mental Health Commission has raised general concerns about the provision of CAMHS, as well as specific concerns regarding children and young people within the care of CAMHS teams in CHOs 3, 4, 5 and 7.

The CEO confirmed that, where individual concerns have been raised by the Inspector of Mental Health Services regarding CAMHS provision in reviewed CHO areas, these have promptly been investigated by the HSE with targeted action plans put in place, as appropriate to the specific concerns. In relation the general concerns raised in the report the HSE has commenced a clinical review of open cases as recommended by the MHC. This review will provide assurance that these children and young people are receiving appropriate care, reflective of their current and future needs.

The Board welcomed the interim MHC report into CAMHS which alongside the National Audits arising from the Maskey Report will be an important contribution to the ongoing work to improve services. The Board expressed concerns and sought further information on the deficits in the current service provisions. They were informed that targeted improvements have been prioritized and investment in recent years, including building capacity in CAMHS and youth mental health, developing specialist services and clinical programmes, suicide prevention, investing in mental health in primary care, modernizing forensic services and digital platforms for accessing services. Building on these ongoing initiatives, the HSE will now move to consolidate and expand its overall youth mental health improvement programme.

The Board emphasised the need to have enhanced capacity, governance and team organisation in CAMHS and welcomed that an overall improvement plan will be driven by a National Youth Mental Health Officer under the leadership of an Assistant National Director and a Clinical Lead for Youth Mental Health, which is currently in recruitment.

It was agreed that the Safety & Quality Committee would provide oversight on the implementation of the recommendations in the report and report back to the Board as appropriate.

Waiting Lists

The CEO informed the Board that while performance on scheduled care remains below NSP targets, linked to the impact of COVID-19 in 2022, there was significant progress in the latter part of 2022. He noted that, given the impact of COVID-19 and the ongoing recruitment challenges, not all waiting list funding was spent in 2022. He confirmed that Hospital Group and Community Healthcare Organisation (CHOs) are currently finalising waiting list plans for 2023. Where practical and appropriate, initiatives that were in place at the end of 2022 are being continued, to ensure that the momentum created in the latter part of 2022 is maintained and built upon in the first half of 2023.

Reconfiguration of Services at Our Lady’s Hospital Navan (OLHN)

• The CEO informed the Board that the extended ambulance by-pass was implemented on 14th December 2022 and has been proceeding as planned and reported on the additional capacity in place in OLHN and Our Lady of Lourdes Drogheda.

The Board noted that the draft response is being prepared to the Minister’s correspondence of December 2002, which raised a number of queries in respect of the wider reconfiguration of OLHN.

The Board discussed their concerns with the slow pace of implementation of the agreed reconfiguration plans noting the Board had endorsed the output of the Working Group in October 2022 and proposed to proceed with the 2 step implementation of the reconfiguration, with Phase 1 completed and agreement to move to Phase 2 at the end of January 2023, but that the reconfiguration has not yet been completed. The Board’s primary concern relates to patient safety and it remains committed to the full reconfiguration of services in OLHN to a Model 2 hospital.

The Board noted that the extended ambulance by-pass has mitigated a degree of risk related to critically ill patients. However, critically ill patients continue to present to OLHN and the risk remains for these patients. It remains the Boards position that the overall risk to patient safety in OLHN remains high and given the higher patient volumes and increased acuity of these patients during the Winter period, this risk increases and that patients should be treated in the most appropriate hospital to meet their needs.

Test & Trace

The Board noted that preparations continue for the final phase of the transition to the end state for mass testing and to ensure continued implementation of the clinical, public health and surveillance led model, inclusive of future sustainability plan. DoH approval awaited. A programme for the 18-49 age groups for their second booster commenced on 29 December 2022, and the figures of the uptake of Health Care Workers for their 2nd booster was discussed along with the multiplicity of approaches which have been taken to improve the uptake.

Human Resources

The Board noted the correspondence submitted relating to Report 42 - Pay Scales affecting Senior Managers. As per a briefing from ND HR to the Chair of the People & Culture Committee, the HSE management wishes to see this matter concluded, however does not have the autonomy to do so. The Board noted that the implementation of any pay increase by the HSE can only follow sanction from the DoH, following approval from the Department of Public Expenditure and Reform. The CEO confirmed that he would be following up on this matter with the DoH.

Provision of Kaftrio

The Board requested an update on the provision of the drug Kaftrio to children between the age of 6 -11 and were informed that negotiations with the supplier concerned are ongoing and the Board will be kept updated with progress

Owenacurra

The Board discussed the on-going closure plan for the Owenacurra Centre, Midleton, Co Cork and correspondence received. The Board requested the Safety & Quality Committee to convene a special meeting, which members of the Board could attend, to consider the draft response to the correspondence and to review the arrangements to transition all the residents to other care facilities and following the Committee meeting to report back to the Board on these matters.

Compliance Framework

The Board noted the Compliance Framework which had been considered by the Audit & Risk Committee. The Board welcomed the implementation of the framework which represents a significant change to the way in which the HSE manages compliance activity across the organisation.

Board Strategic Scorecard - 2022 End of Year Report

The CEO presented the Board Strategic Scorecard 2022 End of Year Report, as circulated prior to the meeting, noting the End of Year scorecard is an integrated report inclusive of November and December 2022 data, and presents the end of year position on the achievement of the annual ambition statements for 2022. The Board discussed the key achievements throughout 2022 and the areas where targets were not achieved. Following the discussion, the Board approved the End of Year Board Strategic Scorecard with one amendment to be made, for submission to the Minister for Health.

National Service Plan (NSP) 2023

The Board noted that discussions are ongoing with the DoH in relation to the Minister’s Letter of Direction of 22 December 2022 and the outcome of these discussions will be reported to the board at its next meeting.

5.1 2023 Board Strategic Scorecard

The CSO presented to the Board for consideration the Board Strategic Scorecard (BSS) Guidance document, and the BSS 2023 blueprints. This includes an ambition statement which sets out what will be delivered in 2023, relevant Key Performance Indicators (KPIs) with annual targets and as appropriate monthly and quarterly targets, and deliverables with target completion date, which were previously reviewed by the Executive Management Team and the Board Strategic Scorecard Subgroup. The CSO thanked the Board Subgroup for its engagement and feedback to date on the development of the programme and priorities for 2023.

The Board agreed that the BSS is a critical accountability tool for the Board and should focus on what will deliver a better service, measure what is important and in the right areas. The Board reviewed and provided feedback on the 20 Programmes/Priorities included in the 2023 BSS Blueprints noting that any in-year adjustments to targets will require Board approval, the need for more balance between KPIs and Deliverables, highlighting focus should be outputs and impacts, timelines to be reconsidered for bringing forward earlier in the year, alignment should be directly to the ambition statement, and targets should have greater ambition while remaining realistic.

In relation to specific scorecards, the following feedback was provided by the Board with consideration to be given to combining Scorecards 1 and 2 (Test and Trace and Vaccines) and Scorecards 16 and 20 (Trust & Confidence and Communications). The Board welcomed the plan to add new scorecards on Unscheduled Care and Women’s Health.

The Board reviewed BSS Recruitment & Retention and requested that a stronger focus be made on Retention. In relation to BSS on Women’s Health it was noted that the KPIs were very narrow and would need to reflect a broader scope and substance. The Board agreed that the BSS would come to the Board first, and if an issue arises it would be referred to the relevant committee for further consideration.

The feedback provided by the Board will be incorporated into the blueprint document and will be considered further at the planned Board subgroup meeting and reported back to the Board at its February meeting.

The Chair thanked Board Members and Management Team members for their time, and thanked Deirdre Madden for deputising as Chair for parts of the meeting. The Chair advised that the next meeting of the Board is an in person meeting with the Minister for Health in February 2023 and that a date will be advised in the coming week.

No further matters arose.

The meeting concluded at 3.25pm.