Board Members Private Discussion
The Chairperson welcomed members to the meeting and provided an update to the Board during their private session on several matters.
Governance and Administration
2.1 Declarations of Interest
No conflicts of interest were declared.
2.2 Chairperson’s Remarks
The Chair provided an update on a number of matters that were covered in the meeting, and briefed the Board on the quarterly meeting held with the Minister for Health on 6 March 2024.
2.3 Ministerial Correspondence
The Board noted correspondence received relating to:
- Letter from Minister for Health ref Clinical governance and performance across all state funded health services, and the use of Health Performance Visualisation Platform (HPVP) dated 20 February 2024;
- Letter from Minister for Children, Equality, Disability, Integration & Youth ref Revised 2024 Approved level of Expenditure and National Service Plan dated 29 February 2024.
2.4 Minutes of Board meeting
The Board approved the minutes of the Board meeting of 20 & 21 February 2024.
Chief Executive Officer
CEO, Executive Business Manager and REOs joined the meeting
3.1 CEO Report
The Chair welcomed the CEO and Regional Executive Officers to the meeting. The CEO Report was taken as read. The CEO reported to the Board on a number of the key significant areas as set out in the report relating to operational matters, strategic objectives, Ministerial priorities and organisational change.
Discussions were held on the following aspects of the report.
Manage the Covid-19 pandemic while delivering health services safely to the public
The CEO informed the Board that there has been a positive and consistent reduction in the number of patients in hospital who have Covid-19 and plans were continuing for the seasonal booster in respect of Covid-19, however he noted the need to remain conscious of the unpredictability in variants. The next seasonal booster is due to be delayed by four weeks, approximately (May 2024), to allow for the ‘ramp up’ in respect of MMR (Measles).
The CEO provided an update on Measles cases to date and the MMR vaccine Catch up Programme, noting that the Incident Management Team (IMT), which was established in early January continue to meet weekly and review the measles situation across the country and internationally to ensure that there is adequate preparedness to both identify cases and the ability to control any outbreaks that may occur. The Board welcomed that there remains a focus on rolling out catch up vaccines to reach target prioritised groups with lower MMR uptake. Prioritisation groups include children; young adults aged 18-24; healthcare workers; and under-served and Beneficiaries of Temporary Protection and International Protection Applicants.
Enhance primary and community services and reduce the need for people to attend hospital
The Board welcomed that performance is continuing well in this area.
Improve scheduled care to enable more timely access and reduce the number of people waiting for services.
The Board was briefed on the Waiting List Action Plan (WLAP) for 2024 which has commenced, and noted that funding of €360 million has been provided. The WLAP sets out 19 actions across three themes, namely Delivering Capacity, Reforming Scheduled Care, and Enabling Scheduled Care Reform. The 2024 Plan builds on progress achieved in 2021, 2022 and 2023 as part of the multi-annual WLAP approach to move closer to achieving the Sláintecare maximum wait times.
The Board welcomed the ambition in the WLAP which aims to achieve approximately a 6% reduction in the overall number of patients on waiting lists by the end of December which represents a significant increase on the 2.7% reduction delivered last year. Also welcomed from a patient perspective was that in 2023, the HSE achieved significant improvements in waiting times.
The Board noted that with targets of volume reduction of 8% and further improvements to be made within specific timelines, that this remains a significant task which is against a further expected growth in new referrals (5% on 2023 as distinct from traditional 2.5%). Recognising that 2023 was also an unprecedented growth year in both referrals and activity (previously reported). The CEO will continue to report on the plan throughout the year via his monthly CEO report.
Prioritise early interventions and improve access to person-centred Mental Health Services
The CEO informed the Board that he had reviewed the position established in 2023 including a dedicated National Child and Youth Mental Health Service (CAMHS) Clinical and Management lead team and was satisfied that there is progress being made to improve services against the backdrop of the Mental Health Commission reports 2023 (2022), Maskey and Kerry.
The HSE Child and Youth Mental Health Office (CYMHO) was established in October 2023 with a National Clinical Lead for Child and Youth Mental Health and a National Lead with responsibility for the CAMHS Service Improvement Programme. This Service Improvement Programme will build capacity in CAMHS and youth mental health.
He confirmed an overall Implementation Plan encompassing these recommendations together with the new policy, Sharing the Vision, is near completion, however it is important to stress that the overall plan is not awaited as improvements are pursued. Recruitment is the challenge of some grades and also the recruitment pause is impacting some teams.
The Board welcomed this update noting that the Safety and Quality Committee and the Planning and Performance Committee had held a joint meeting during the month to review the range of mental health services delivered by, or on behalf of the HSE. This was further discussed in the Committee reports section.
Work to reimagine Disability Services, to be the most responsive, person-centred model achievable with greater flexibility and choice for the service user
An update was provided regarding the provisions in the new Centre design for enhanced capacity on the development aspect of Disability Services while also having visibility of disability services in each region. The Board welcomed that the National Office and structure for Disability services is due to be populated in the coming weeks and the CEO agreed to provide a further update in his next report to the Board.
Urgent and Emergency Care (UEC)
The Board noted the CEO’s concern regarding the upward trend and growth in activity within emergency departments compared to 2023. The CEO provided an overview of how improvements are being managed to address this, noting that discharges have increased by an average of +143 (16%) per day, with Trolleys & Wards continuing to remain static. Surge has grown +95 (31%) beds per day with Delayed transfers of care (DTOC) patients have reduced by -186 (-33%) per day.
As a sense of the scale of variables across activity relevant to UEC, the CEO set out a comparator for the public holiday period (St Patrick’s Day) 2024 v 2023, noting that attendance increased by 12.6% and admittances by 13.6%.
The Board discussed the significant challenges and their concerns regarding UEC. They highlighted the significant requirements for recruiting and retaining staff Nurses and Midwives that are required in order to maintain existing levels of service in addition to service developments as provided for in the National Service Plan. They welcomed the decision that all Nursing and Midwifery graduates from Irish colleges for 2024 are offered permanent contracts of employment and noted that retention of all 2024 Nurses and Midwifery graduates across the service is a key action as part of the approach to optimise resourcing needs.
The Board also highlighted the importance of ensuring that all staff work to their full skill set and the CEO echoed his agreement and the importance of ensuring Older People continue to be provided with the best possible pathways to support them in UEC.
University Hospital Limerick (UHL)
The Board were informed that the CEO and Minister are planning a visit to UHL in early April and further additional steps and measures to support UHL are currently being discussed, these included proposals around operating acute medical units on a 24-hour period, the introduction of stepdown facilities and an increase in bed capacity across the region. While the Board welcomed the proposals it was acknowledged that these proposals were yet to be finalised and further discussions needed to take place.
Noting the challenges within UHL, the Board sought assurances with regards to staff morale and how it is being managed in the region. The Mid West Regional Executive Officer (REO) provided a high-level overview of her initial priorities and areas of focus. These included understanding the population needs of the region, ensuring the correct pathways are in place to address these needs and building upon and strengthening areas around social inclusion. The Board, along with the CEO and REO acknowledged the hard work and dedication of the staff working in UHL.
Patient Safety Protocol
The Board were informed that the CCO continues to receive updates on the Independent Review into matters regarding spinal surgery at Children’s Hospital Ireland (CHI) and when finalised this will be brought back to the Board at a future meeting for discussion.
Employment Control & Industrial Relations
The Board were informed that the workforce in December 2023 was 125,420 WTE compared to December 2019, 101,540 WTE (four-year activity) which was + 23,880 WTE (growth of 23%) with a net year on year increase +7,577 in 2023.
The CEO confirmed that the 2024 Pay & Numbers Strategy (PNS) has been submitted to the Department of Health (DoH) and he is engaging further with the DoH and will revert to the Board when a response has been received. He also outlined that his planned approach for 2024 will be to allocate to each unit their specific listed workforce allocation and that this will lead to each area being accountable and in control of their area.
Health Regions & Organisational Change
The Board welcomed the transition to the Health Regional Offices model which commenced in March and also the commencement of the move to the new HSE Centre structure. It was noted that current systems will remain in place as necessary during this period to ensure safe transition and to make sure services are maintained.
The objective of these new ways of working is to see strengthening of local leadership and a detailed discussion was held by the Board on the model being implemented and on ensuring local decision-making alignment to hospital and community-based services in each region is in place so regions can work together better and deliver joined-up, co-ordinated care closer to home care.
The Board also discussed that the change also sees Health Regions, their teams and services being supported by a smaller national HSE and these combined operational changes were noted as an important part of putting Sláintecare in action.
The Board discussed and supported that the implementation of fundamental change at the HSE Centre is to allow the regional structures to have the intended level of appropriate authority and operational control of services in their region. The Health Regions will be the operational entities of the HSE, reporting to the CEO, and the purpose of the Centre will be to resource and support the REOs.
While welcoming and supporting progress to date, the Board highlighted the importance of ensuring that there is a clear pathway and process set out to ensure compliance and that governance is delivered throughout. The Board also discussed the importance of managing culture change.
Health Performance Visualisation Platform (HPVP)
The CEO informed the Board that all remaining hospitals intended for Phase 1 roll out of the HPVP system have confirmed in writing that they will implement the platform.
Arrangements have been made to support each site with implementation, both from the HSE Centre and with resources soon to be embedded in the 6 Health Regions. Progress will be closely monitored, learnings from Phase 1 roll out of HPVP will inform the next Phase, and future similar developments will require the engagement and cooperation of both HSE and Section 38 hospitals.
3.2 Clinical Governance Operating Model and National Quality & Patient Safety Model in Centre Design and Regional Structures
EMT members joined the meeting
The CEO informed the Board that following consultation it is proposed that a new National Quality and Patient Safety Unit will be established under the remit of the CCO with strong relationships with the DoH Patient Safety Office and the Safety and Quality Board Committee.
A discussion was held on the proposal and the Board queried how risk would be dealt with under the new structure, and it was confirmed that structures that have been in place to manage risk will be preserved and reviewed accordingly. The Board supported the direction of travel to date, and it was agreed that it would be brought to the Safety & Quality Committee meeting in April and that the Board would receive a further update at the next meeting.
3.3 Implementation Plan National Taskforce on the NCHD Workforce Recommendations
The Board agreed that the Chair’s letter enclosing the Update on the Implementation Plan - National Taskforce on the NCHD Workforce Recommendations which outlines the HSE proposals and timelines for implementation of the interim and final report, which was reviewed by the People & Culture Committee be submitted to the Minister for Health, in response to his letter of 6th February 2024.
3.4 Board Strategic Scorecard
Reviewing the Board Scorecard, the CEO informed the Board that the March 2024 Board Strategic Scorecard reports on January 2024 KPI data and includes the most current progress update of key deliverables across all 19 scorecards at the time of reporting. He noted that data collection had improved post the industrial action, however there was still some backlog in respect to aspects of it. He noted the PNS approval, affordable WTE limits and other ongoing IFMS validation exercises impacted the reporting of data and progression of deliverables across a number of Scorecards.
The Board approved the March report for submission to the Minister for Health in line with reporting requirements noting that management will continue to actively work with Department officials to further mature the Report as a critical reporting tool.
Committees of the Board Briefings
4.1 People and Culture Committee
The minutes of the Committee meeting of 12 January 2024 and HR Dashboard (January data) were noted. In the absence of the Committee Chair, Committee member Matt Walsh provided a verbal report on the matters considered at the Committee meeting that took place on 12 March 2024.
The Committee approved the draft Committee Annual Report section.
The HR Bi Monthly report was presented to the Committee, which included an update in relation to the suspension of the Fórsa Industrial Action and the agreement to develop a specific Framework in relation to the recruitment of management and administrative staff which will be done in the context of the PNS. Also included was an update on the Diversity, Equality & Inclusion– staff with disabilities survey; the Health Sector Workforce Census data; the number of Consultants currently employed on the Public Only Consultant Contract; and that the People Strategy 2019 - 2024 would be reviewed at a future Committee meeting.
The Committee reviewed the HR Internal Management dashboard, and noted that the PNS is in its final stages, with the expectation that the final WTE limits will be issued to inform discussion of the HR dashboard at its next meeting.
The Committee received an update on the Implementation Plan currently under development relating to the National Taskforce on NCHD Final Recommendations Report, noting the significant progress being made in relation to the interim recommendations, and that costing of the recommendations is required. The Committee noted that feedback on the implementation of the interim recommendations has been positive.
The Committee received an update in relation to the Corporate Risk Register. The Health Regions programme was discussed, with the Committee noting the cultural shift involved in devolving authority and accountability to the Regions, and were advised that a Culture Framework has been devised and finalised.
The Committee were briefed on the HSE’s approach to Succession Planning, and agreed to have an end of year review exploring the complexities of succession planning.
4.2 Safety and Quality Committee
The Committee Chairperson advised the Board that a Joint Committee meeting with the Planning & Performance Committee took place on 14 March 2024 to discuss Mental Health. The Chair provided a verbal report on the different areas of mental health service delivery, policy implementation, current challenges and prioritised areas for service improvement considered at the meeting and acknowledged the work of the ND Community Operations and team.
The Committees were presented with two service users experiences of accessing mental health services on behalf of a family member through Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS). Both highlighted similar issues within these services, noting that the complexity of the current system requires significant work on behalf of the service user to successfully navigate. Both Committees highlighted that the HSE should make better use of lived experiences of service users, as these experiences tell us so much about the effectiveness, safety and quality of the services we provide. The ND Community Operations confirmed they do aim to do this as much as possible in service development.
The Committees received an overview in relation to mental health services under General Adult Mental Health; Child & Youth Mental Health; Psychiatry of Later Life; Mental Health of Intellectual Disability; and Forensic Services. The Committees discussed the importance of access to these services noting referrals by GPs; performance data for CAMHS; the redefining of KPIs with the emphasise on the need for a modernised IT system; the impact of the recruitment pause, and the problems caused by the lack of multiannual funding.
The Committees were provided with an update on the Policy & Strategy landscape areas, which covered Sharing the Vision; Connecting for Life; the Maskey Report; and Sláintecare and integration. The Committees discussed the implementation of the recommendations of Sharing the Vision and the 10 work streams underway to achieve them. In relation to the implementation framework for the Maskey Report it was noted that recommendations in 3 broad areas: clinical, governance and supporting, are now being considered in services across the country.
In relation to Regulatory Compliance, the Committees discussed the Mental Health Commission (MHC)’s Annual Report 2023, and it was highlighted that the MHC expressed ongoing concern about low levels of compliance with four key regulations. The Committees were also advised that the HSE has agreed to support broadening of the MHC’s remit to allow regulation to residential community mental health services.
Following the joint meeting, the Safety & Quality Committee went on to consider items on its monthly agenda.
The minutes of the Safety & Quality Committee meeting of 15 February 2024 were approved.
The Committee approved the draft Committee Annual Report section, and the monthly Chief Clinical Officer’s Report was presented to the Committee. This included an update on the Development of a HSE Laboratory Strategy; the Public Health Reform Expert Advisory Group (PHREAG); the Sepsis and HSE Awareness campaign; the HSE CHI Independent Review; delays in Breast Check surgery resulting from recruitment challenges and theatre access issues.
The Committee provided feedback to the CCO on the new Quality and Patient Safety Model, which aims to create a leaner corporate centre for the HSE and noted that the existing infrastructures around incident management and risk will be dealt with under the new structure.
The Committee noted the Quality profile from the January data cycle.
4.3 Planning and Performance Committee
The Committee Chair advised the Board the he and another Committee member had met the CSO and team to discuss the draft HSE Annual Report 2023 and a further meeting was being arranged to finalise the Annual Report, which would be then brought back to the Board for approval.
4.4 Technology and Transformation Committee
The minutes of the Committee meeting of 24 January 2024 were noted. The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 20 March 2024, and advised the Board that Committee meetings will now take place monthly.
The Committee approved the draft Committee Annual Report section, and noted updates relating to eHealth Talent Plan, Microsoft reseller agreement renewal and IFMS.
The Committee discussed the eHealth section of the BSS (January KPI data), noting that there will be more to be learned from the data provided later in the year.
The Committee reviewed the CTTO Air Traffic control dashboard, with a discussion on staffing and highlighted the importance of succession planning. An update on the current ICT Capital Plan spend was provided, and the Committee requested a 3-year rolling plan of eHealth projects. Also included was an update on the Change Healthcare cyber-attack which occurred in the US in February 2024, with assurance that there was no compromise of HSE service as a result of this cyber-attack.
The Committee received an update on progress in relation to the HSE Digital Health Strategic Implementation Plan (DHSIP), and subject to the Department of Health’s internal governance, the Committee agreed to recommend the DHSIP to the Board for approval on the provision that updates are provided on governance as it progresses and on the communications surrounding the eventual launch.
The Committee were presented with an update in relation to the development of Acute Virtual Wards (AVW), and expressed their full support for the development.
In relation to the Health Regions, the Committee were presented with an update on the work completed to date, the key next steps and deliverables for the implementation of Health Regions. The Committee discussed the organisational structure and the proposals to manage ICT risks within the new structures.
The Committee were provided with an update on the Prioritisation Framework for Transformation, and were provided with examples of some programmes and emphasised the importance of a clear model to work within for the delivery of these programmes.
The Committee discussed the approach to date to design a HSE Business Continuity Management (BCM) Policy and Handbook, with final drafts due to come back to the Committee. It was noted that the Audit & Risk Committee would take the lead in relation to the BCM.
4.5 Audit and Risk Committee
The minutes of the Committee meeting of 19 February 2024 were noted.
The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 22 March 2024 as follows.
The Committee approved the draft Committee Annual Report section.
The Committee were provided with an update in relation to the National Children’s Hospital (NCH) Project and Programme, and noted the significant issues and risks with this large and complex programme. The Committee discussed the operational and governance accountabilities of CHI, and noted that an external assurance review was commissioned, and once completed would be brought before the Committee.
The Committee had considered the detail of proposed building contracts, and recommended approval to the Board.
The Committee received updates in relation to YTD Expenditure and Health Budget Oversight Group, and were presented with the draft Annual Financial Statements (AFS), which are being presented later in the meeting.
The Committee were provided with an update in relation to IFMS and the significant challenges and measures identified relating to invoice processing for Implementation Group 1 (IG1). A paper seeking the approval of the Change Control Note (CCN) to the IFMS System Integrator contract for SAP Implementation Support for a new IFMS was presented and the ARC agreed to recommend to the Board for approval.
The Committee considered the Corporate Risk Register (CRR) 2024, with members providing further feedback to the CRO. The CRR 2024 will be presented to the Board at the April 2024 meeting. The Committee were provided with an update on the engagement and training programme associated with the roll-out of the Enterprise Risk Management Policy and Procedures; and noted the position of Risk Management within the Health Regions.
The Committee noted three reports with regard to Protected Disclosures, which were the Statutory Report 2 to the Minister of DPER, the Protected Disclosures Annual Report 2023, and the National Office for Protected Disclosures Report for January – December 2023.
The Committee reviewed the Interim Audit Report 2023 and noted that Limited assurance can be provided in respect of the governance, risk management and control systems operating in the subject areas audited. The Committee noted in the report the good progress on actioning of Audit Recommendations and the modest improvement of the Audit Ratings, and outlined its aspiration for 2024. It was noted that an Access and Cooperation Escalation Protocol, will be brought before the ARC at its April meeting. The Committee received an update on the IA Strategic Review and Industrial Relations, and in relation to the successful tender for an outsourced ICT audit provider.
Board member M O’Sullivan left the meeting @ 12.50pm
Reserved Functions of the Board
5.1 Adoption of Draft AFS 2023 in line with Health Act 2004
The CEO recommended the draft Annual Financial Statements (AFS) 2023 to the Board for adoption. The Documents presented were the:
- draft Financial Statements 2023 and notes to the Accounts including draft accounting policies (AFS);
- draft Statement on Internal Control (SIC)
The ARC Chair advised the Board that the ARC had reviewed the draft AFS 2023 at its meeting on 22 March 2024 and discussed the Statement of Internal Control (SIC), noting that the HSE has conducted a review of the requirements of the DPER Code to ensure that the SIC is compliant with same. On the basis of that review the Committee were advised of amended wording in the conclusion which was deemed more appropriate in that context. The Committee agreed that this wording is the most appropriate in the context of the SIC, which was presented to the Board.
The ARC Chair on behalf of the ARC recommended the draft AFS to the Board for adoption.
In accordance with the requirements of Section 36 of the Health Act 2004, the Board adopted the draft AFS and draft Statement of Internal Controls for submission to the Minister for Health and Minister for Children, Equality, Disability, Integration & Youth and the C&AG for audit and the Chairperson and CEO were nominated to sign the accounts. Decision No.: 270324/11
The Board noted that the audit is on-going and the accounts will not be considered final until the audit has concluded and any material changes that may arise have been considered and actioned. It is expected subject to the progression of the C&AG audit that the final draft will be brought to the Board in May and any material changes to the AFS and disclosures will be explained.
5.2 Contracts & Properties
The CEO presented to the Board the following papers which were recommended by the ARC for approval, to which the Board considered and approved.
- Change Control Note – IFMS System Integrator Contract Board Decision No.: 270324/12
- Award of Contract Community Nursing Unit, Roscommon Board Decision No.: 270324/13
Board Strategic Focus
Jackie McIlroy and Paula McShane, CEO office joined the meeting
6.1 Review of Adult Safeguarding Policy, Procedures and Structures in the HSE and Proposed Future Directions for Safeguarding
The CEO introduced Ms Jackie McIlroy to the meeting, and advised the Board that Ms McIlroy was commissioned by the HSE as an independent external reviewer to conduct a high level review of the HSE safeguarding policy, procedures, structures and advise him on the possible options for the future of safeguarding recognising that the HSE has roles in safeguarding in both the community and alternative care settings for adults.
The Board Strategic Focus paper on the Review of Adult Safeguarding Policy, Procedures and Structures in the HSE and Proposed Future Directions for Safeguarding was presented to the Board for review, endorsement and approval for publication.
Ms McIlroy provided an update to the Board and advised that the review has a vision for adult safeguarding that places safeguarding at the heart of all that the HSE and all public, private and voluntary agencies funded through public monies do, to provide a health and/or social care service. Extensive meetings were held with staff, families, people who have used services and key stakeholders across health and social care, with four engagement events held across the country, and with numerous bodies and organisations. She also met individually with family members and nursing, medical and social work staff and received written submissions from individuals and organisations.
The Board discussed the report presented, and supported the recommendations outlined in the report, noting that to move forward the organisation needs to:
- Embed a safeguarding culture,
- Increase the visibility of safeguarding,
- Support a strong change management process,
- Embed a culture of learning and improvement.
The Board recognised that it was an opportunity to bring about a meaningful change in how the organisation supports and protects some of the most vulnerable members of the population, which will require energy and commitment from the organisation as a whole, and that the Implementation plan must be championed across services and blockages to implementation would need to be urgently addressed. It was noted that Safeguarding was on the Safety & Quality Committee Workplan and further updates will be brought back to the Board through the Committee Chair.
Jackie McIlroy and Paula McShane, CEO office left the meeting
Any Other Business and Close
There was no further business. The meeting concluded at 14.05.