HSE board meeting minutes 28 June 2024

Attendance:

Board Members

Mr Ciarán Devane (Chairperson), Dr Yvonne Traynor (Board Member), Mr Brendan Whelan (Board Member), Mr Aogán Ó Fearghaíl (Board Member), Ms Anne Carrigy (Board Member), Mr Matt Walsh (Board Member).

Remotely

Ms Michelle O’Sullivan (Board Member), Mr Tim Hynes (Board Member).

Office of the Board

Mr Dara Purcell

(Corporate Secretary

Ms Niamh Drew

(Deputy Corporate Secretary

Ms Patricia Perry

(Office of the Board

In Attendance for Board Meeting:

Mr Bernard Gloster

(Chief Executive Officer (CEO)

Ms Niamh Doody

(CEO - Executive Business Manager

Joined the meeting:

Mr Damien McCallion (Chief Technology & Transformation Officer (CTTO)), Mr Pat Healy (National Director, National Services and Schemes), Mr Stephen Mulvany (Chief Financial Officer (CFO)), Mr Tony Canavan (REO West & North West), Ms Sandra Broderick (REO Mid-West), Ms Sara Long (REO Dublin & North East), Ms Kate Killen White (REO Dublin & Midlands), Dr Andy Philips (REO South East), Ms Anne Marie Hoey (Chief People Officer (CPO)), Mr Joseph Duggan (Chief Internal Auditor (CIA)), Mr Patrick Lynch (National Director Planning & Performance), Ms Grace Rothwell (National Director, Acute Operations), Dr JP Nolan (Head of Quality & Patient Safety), Prof Martin Cormican (Clinical Lead for Laboratory Services Reform Programme), Ms Mairead Dolan (Asst Chief Financial Officer (Asst CFO)), Mr Brian O’Connell (Interim National Director, Capital & Estates), Ms Miin Alikhan (AND Planning).

The Chairperson welcomed members to the meeting and provided an update to the Board during their private session.

1.1. Declarations of Interest

No conflicts of interest were declared.

1.2 Chairperson’s Remarks

The Chairperson provided an update to the Board on the following matters:

• Briefing on quarterly meeting held with the Minister for Children, Equality, Disability, Integration & Youth (CEDIY) and Minister for Disabilities on 27 June 2024;
• Recruitment process for the appointment of new Board Members;
• Reappointment by the Minister for Health of Board Members Michelle O’Sullivan and Matt Walsh;
• Noted that discussions regarding Board Committees would take place at the July Board meeting;
• Agreed that no Safety & Quality Committee and Planning & Performance Committee would be held in July 2024.

1.3 Ministerial Correspondence

The Board noted correspondence received relating to a letter to Minister for Health re Performance & Improvement dated 18 June 2024.

1.4 Minutes of Board meeting

The Board approved the minutes of the Board meeting of 29 May 2024.

CEO and Executive Business Manager joined the meeting

2.1 CEO briefing to Board

The Chairperson welcomed the CEO to the meeting. The CEO provided an update to the Board on work to reimagine Disability Services and advised that the Cabinet Committee on Children Education and Disability scheduled for 24 June 2024 was deferred. He and senior HSE officials have had ongoing engagements with the Departments of Education; CEDIY; and An Taoiseach.

The CEO reported that the areas of both Assessment of Need (AON) and children waiting for services from the new Children’s Disability Network Teams (CDNTs) remain the significant challenges in the reform and these are a source of concern to many.

2.2 CEO Monthly Report

Members of the Senior Leadership Team joined the meeting

The CEO reported to the Board on a number of the key significant areas as set out in the CEO Monthly Report. Focus discussions were held on the following areas;

Engagements and correspondence with the Minister for Health, Secretary General and CEO/Senior Leadership Team (SLT) relating to the Waiting List Action Plan (WLAP), and particularly the actions set out in the correspondence of 17 June 2024 to the REOs which require specific focus.

Discussions were held on progress with the implementation of the WLAP for 2024. The Board noted that the performance data shows that there have been significant reductions in the number of patients waiting longest. However, higher than anticipated levels of additions to waiting lists has resulted in the volume of patients waiting across lists remaining high. The CEO confirmed that while the higher than targeted level of removals were offset by higher than anticipated additions to waiting lists, the high number of removals are reflective of the increased levels of activity being achieved in the delivery of scheduled care in acute hospitals.

The Board acknowledged that the volume of increased additions were identified as a risk as part of WLAP, and the projections for this year considered the experience in previous years. The CEO informed the Board he is considering how to develop a strategic capability for modelling to improve activity projects for scheduled care.

The Board emphasised that a strong focus on productivity and performance management and accountability is required to continue to ensure that investment and existing resources are maximised.

The Board were informed that following the publication of the Mental Health Commission (MHC) Annual Report on 25 June 2024, a meeting with the CEO of the MHC and HSE National Leads is being arranged. HSE National Mental Health is developing a detailed action plan in response to findings, and the action plan will be presented to the HSE’s Safety and Quality Committee for consideration.

The CEO advised the Board that Urgent Care remains a pressured area with challenges in five sites, however there have been improvements in four of those.

The CEO informed the Board that Covid 19 is likely to see some increasing numbers in cases before a decline, which is expected to occur at the end of June or early July. He advised that the Department of Health (DoH) have asked the HSE to implement the nasal seasonal flu vaccine (LAIV) to those aged 2-17 years old in 2024-2025 and to extend the provision of the vaccine within primary schools. A funding plan has been submitted to the DoH to enable this programme to be implemented, and preliminary planning is taking place while a response is awaited.

Discussing Employment Control & Industrial Relations, the CEO advised the Board that a meeting was held with the Ministers for Health and Public Expenditure NDP Delivery & Reform (DPENDR) regarding the financial position, which is connected to Pay and Numbers Strategy (PNS) 2024. The Board noted the data for 5 months of the year to end May 2024, which shows a decrease of -200 WTE before any adjustments. The CEO also updated the Board in relation to industrial relations matters.

The Board welcomed the establishment of the Productivity Unit and were advised that the new SLT has now commenced and previous processes and structures for Governance at the centre have ceased. Two posts remain to be filled in the Centre and both are currently at competition. The CEO advised that he continues to pursue key engagements, all of which contribute to the process of improved performance and public confidence.

Discussing Finance, the CEO advised that he has had continued engagements with the DoH and DPENDR and advised the Board of the up-to-date position. The Board expressed concern not having a finalised PNS, and highlighted that this is preventing each Region and National Service to move forward, due to the fact that half way through the year, there are no detailed notification of the respective allocations for 2024 and so are unable to move forward with certainty for the rest of the year.

The Board noted there is an expectation that discussions with Government will be finalised shortly on the funding position and the approved PNS.

Digital Health Framework and Roadmap

The CEO presented to the Board the HSE’s Digital Health Strategic Implementation Roadmap (Roadmap) for approval.

He outlined that the DoH under the Assistant Secretary began work in 2023 on developing a new national Digital Health Strategic Framework (Framework) aligned with Government’s “Harnessing Digital - The Digital Ireland Framework”.

The Office of the CTTO developed the Roadmap in collaboration with the DoH and outlines how the Department’s vision and principles can be delivered with 48 initiatives over a now-next-future time continuum. He highlighted the ambition and establishment of targets for Digital Health, guides the necessary policy choices, and inform funding decisions for consideration by Government, that reflect our national ambitions to leverage digital in delivering health services, improve the state of Digital Health in Ireland, and fulfil upcoming EU obligations.

The Chair of the Technology & Transformation Committee advised the Board that the Roadmap was approved at the HSE Steering group which governed its development, brought to EMT and SLT for approval, and subsequently to the Technology & Transformation Committee. He acknowledged the huge amount of work done by the CIO and former CTTO.

The Board considered and discussed the Framework and Roadmap and approved Digital Health Strategic Implementation Roadmap.

Board Strategic Scorecard

The CEO confirmed that three scorecards reported a downgrade in their rating, and all other scorecards maintained their rating. He advised that the PNS until finalised continues to impact the reporting of data and progress of deliverables across two Scorecards. The Board approved the Board Strategic Scorecard for June 2024, reflecting April 2024 data, for submission to the Minister for Health, and the Department of Children, Equality, Disability, Integration and Youth.

3.1 Audit and Risk Committee

The minutes of the Committee meeting of 10 May 2024 were noted.

The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 07 June 2024 noting the final draft Annual Financial Statements (AFS) 2023, and were provided with an update on the material changes to the final draft AFS 2023 since the adoption by the Board on 27 March 2024, which would be discussed under the Reserved Functions.

The Committee received an update in relation to the YTD Financial Position as at April 2024. The Committee discussed the newly established Productivity Unit and met with the Chief Risk Officer. The Committee were also updated on the strategic considerations and direction of the Internal Audit Division by the CIA and in relation to the Internal Audit Industrial Relations matter. The Committee had also noted the assessment in relation to the Quality Assurance and Improvement Program.

The Committee reviewed the Capital Plan 2024 and noted that the overall expenditure compared with the profile position at the end of April 2024 is below profile, which is impacted by the National Children’s Hospital. The Committee have requested that Capital & Estates provide periodic updates to the Committee in relation to any material adjustments to the Capital Plan. The Committee discussed the National Children’s Hospital - Operational Readiness Review and noted the external assurance review which was undertaken by an international expert. The Committee Chair highlighted that the Committee nor the Board has had sight of the external assurance review and Implementation Plan.

In relation to the programme management and programme oversight arrangements, the Board discussed how it wished to enhance its oversight, as the HSE will be accountable. It was agreed that the Board would be regularly updated on the issue going forward. The Committee had also considered the detail of a proposed acquisition and recommended approval to the Board, and advised that the Committee also reviewed a contract award recommendation, but that it would not be presented to the Board at today’s meeting.

4.1 Final Annual Financial Statements

The Board reviewed with the CEO, CFO and Asst CFO the final draft AFS 2023, notes to the accounts, Statement of Internal Control (SIC), Operating and Finance Review (OFR), Letter of Representation (LOR) 2023, Chair’s Comprehensive Report and draft C&AG audit certificate, which had been circulated in advance.

The Board welcomed that the C&AG will provide a clean audit certificate following the audit of the AFS and noted the matters that may be emphasised in the C&AG audit certificate.  

The Board proceeded with their re-adoption of the AFS and related documents on the grounds that they have been recommended by the Audit & Risk Committee as confirmed by the Committee Chairperson and nominated the Board Chairperson and the CEO to re-sign these accordingly.

Decision No.: 280624/27

4.2 Contracts and Properties

As recommended by the Audit & Risk Committee for approval, the Board considered and approved the proposed acquisition of a building in North County Dublin

Decision No.: 280624/28

AND Planning joined the meeting

5.1 Board Workshop re Development of HSE Corporate Plan 2025 - 2028

As the current Corporate Plan expires in 2024, work has commenced on developing the new Plan. Noting the legislative requirement regarding the production of a three-year Corporate Plan, the ND Planning and Performance advised the Board that the purpose of the discussion at the meeting was to seek direction in relation to the development of the HSE’s Corporate Plan 2025 - 2027 (the Plan).

The Board outlined that access continues to be the fundamental challenge and needs to be central to the Plan with a system-wide focus to include primary care and community and acute services; a clear mission statement that communicates the purpose and direction to the public, patients / service users, staff and stakeholders is required; the Plan should address major planned infrastructural developments and should articulate the HSE’s commitments on: building change capability with an emphasis on optimisation of resources, value and productivity; the strengthening of service integration through the new health regions and partnerships, the HSE as a learning organisation and ensuring continued evidence-based decision-making throughout the organisation; the inclusion of milestones and achievements; and the importance of the language used in the Plan.

The Board noted that the Plan’s aim would be for three years but within a five year planning horizon; that it would be a short document but would balance the need to have the right amount of detail to allow focus on efforts over the next three years. The Board welcomed that it should be built around 5 to 6 major themes or strategic commitments that will set out key priority actions over the next three years and should set out how success in delivery should be measured. It was noted that the Plan would be structured to support logical flow into the three National Service Plans 2025, 2026 and 2027 and would provide the focus for Board reporting and a revised Board Strategic Scorecard. The Plan would also recognise the opportunities resulting from the establishment of the new HSE Regions.

The Board welcomed the engagement with key stakeholders and noted further workshops and engagements would be held going forward, including with the DoH, as the Plan develops.

The Board welcomed the direction of the Plan so far and it was agreed that a further update would be brought to the Board in July.

SLT left the meeting

There was no further business. The meeting concluded at 2pm.