HSE board meeting minutes 29 November 2024

Present

Mr Ciarán Devane (Chairperson), Mr Brendan Whelan, Mr Aogán Ó Fearghaíl, Mr Tim Hynes, Ms Anne Carrigy, Ms Michelle O’Sullivan, Mr Matt Walsh, Ms Lily Collison, Mr Michael Cawley and Mr Kenneth Mealy

Apologies

Dr Yvonne Traynor

In Attendance for Board Meeting

Mr Bernard Gloster (CEO), Mr Brian Murphy (Head of Corporate Affairs), Ms Sara Maxwell ( CEO Office), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Deputy Corporate Secretary), Ms Patricia Perry (Office of the Board)

Joined the meeting

Mr Damien McCallion (CTTO), Mr Stephen Mulvany (CFO), Mr Pat Healy (ND Services & Schemes), Ms Anne Marie Hoey (CPO), Ms Grace Rothwell (ND Access & Integration), Mr David Walsh (ND Access & Integration), Mr Tony Canavan (REO West & North West), Ms Sara Long (REO Dublin & North East), Ms Kate Killen White (REO Dublin & Midlands), Ms Martina Queally (REO Dublin & South East), Dr Andy Philips (REO South East), Ms Janette Dwyer (Regional Director of Service Integration Mid West); Mr Joseph Duggan (Chief Internal Auditor); Mr Brian O’Connell (Interim ND Capital & Estates); Mr Patrick Lynch (ND Planning & Performance); Mr Mark Brennock (ND Communications); Mr Donan Kelly (AND Child and Youth Mental Health Office), Mr John Meehan (AND HSE National Office for Suicide Prevention) Dr Amanda Burke (Clinical Lead for Youth Mental Health) and Dr Amir Niazi (National Clinical Adviser and Group Lead for Mental Health)

Minutes reflect the order in which items were considered and are numbered in accordance with the original agenda.  All performance/activity data used in this document refers to the latest information available at the time.

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

2.1. Declarations of Interest

No conflicts of interest were declared.

2.2 Chairperson’s Remarks

The Chairperson provided an update to the Board on a number of matters that would be discussed during the meeting. He advised that a Board member met with the Nursing & Midwifery Director of the HSE and the Chief Nursing Officer in the Department of Health (DoH) to discuss the topic of nurses working to their scope of practice.

The Chair advised the Board that the Quarterly meeting with the Minister for Health is due to take place on 11 December 2024, and thanked Board members for partaking in the selectors panel for the 2024 Health Service Excellence Awards.

The Board discussed appointments of members to Board Committees and it was agreed that a draft proposal would be circulated for review and brought back to the December meeting for approval.

2.3 Ministerial Correspondence

The Board noted the following correspondence.

• Letter to Minister for Health re Medicines Reimbursement Process and Medicines Tracker dated 24 October 2024
• Letter from Minister for Health re 2024 Revised Approved Level of Net Expenditure dated 01 November 2024

2.4 Minutes of Board meeting

The Board approved the minutes of the Board meeting of 23 October 2024.

3.1 Audit and Risk Committee

The minutes of the Committee meeting of 04 October 2024 were noted, and that a briefing of the meeting held on 01 November 2024 would be given at the next Board meeting.

Clarification was sought in relation to item relating to a report on final account for completed commercial projects discussed at the October meeting, and the CFO will provide further information.

3.2 Performance Committee

The Committee Chairperson provided an update to the Board in relation to meetings held with regard to the establishment of the Committee and advised that the Committee is due to meet on 10 December 2024.

3.3 Strategy and Reform Committee

The Committee Chairperson provided an update to the Board in relation to meetings held with regard to the establishment of the Committee and advised that the Committee is due to meet on 11 December 2024. The name change from Transformation Committee to Strategy and Reform Committee was noted.

Appointment of External Member

The Chairperson of the Committee requested that the Board approve the appointment of Sarah Barry, Barry Lowry, Derick Mitchell and Martin Mc Cormack as external members of the Strategy and Reform Committee for a term of 3 years until 28 November 2027, which the Board approved.

Board Decision No.: 291124/50

CEO and Head of Corporate Affairs joined the meeting

4.1 CEO briefing to Board

The Chairperson welcomed the CEO to the meeting.

As previously requested by the CEO to the Chair, the three Board members identified, Anne Carrigy, Matt Walsh and Michelle O’Sullivan, to be in reserve for potential future functions in regard to University Hospital Limerick (UHL), left the meeting and recused themselves for the duration of the CEO briefing to the Board on matters related to UHL and HR Process. On the conclusion of the CEO’s briefing, the three Board Members rejoined the meeting.

4.2 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:

The CEO reported that the Covid-19, flu and RSV epidemiology continues to be monitored, noting the vaccine coverage is lower than target and lower than the same period last year

The CEO advised that Scheduled Care has seen similar rises in demand to Unscheduled Care, with outpatient referral rates currently 7.4% greater than the same period last year. It was noted that the output has increased during this time with 6.1% more patients taken off the waiting list, but despite the increase, the outpatient waiting list has grown by 15,000 this year. The Board noted the Weighted average Wait times (WAW) for patients awaiting an OPD appointment, that treatment has dropped to 6.9 months, from 7.5 months at the start of 2024, and of the patients receiving treatment, about 30% of all outpatients never go into Sláintecare breach times (10 weeks).

The Board welcomed the focus in the NSP 2025 in relation to the time people are waiting for services rather than the overall volume waiting for services in Scheduled Care, and that focus that was effectively applied to acute and outpatient waiting lists in previous years will be similarly applied to primary and community services going forward.

The Board discussed the issue of the interim ICT solution for community services being delayed from the original plan, as it is now assimilated into the wider community IT approach, and noted that the Community Connect System will commence implementation in 2025.

The CEO advised that access to community diagnostics continues to perform ahead of target, reducing the need for people to attend in-hospital diagnostics, which creates some challenges on the appropriateness of referrals for investigations and the sustainability of that increasing cost over benefit.

Discussions were held in relation to Unscheduled Care, noting a continuing trend of increases in demand during November. The Board were advised of the reintroduction of additional national oversight engagements with REOs to ensure maximum performance management of the system and appropriate national support.

In relation to Disability Services, the CEO advised the Board that he is continuing discussions with the Secretary General DCEDIY on the need for the approach and models to be reconsidered to improve access and outcomes in disability services, particularly children’s disability services. The Board welcomed the approach and the Performance Committee will continue to engage on this matter.

The Board discussed the Healthy Ireland Implementation Plan 2025 - 2027, which includes provision for Regional Healthy Ireland Plans to be developed in conjunction with the communities that they serve, with a key focus on early intervention for disease prevention by focusing on potential environmental and behavioural risk factors for chronic disease.

The CEO provided an update in relation to the CEO vacancy at CHI, and the Board welcomed that the matters had now been resolved, with a five year appointment approved by the Minister.

In relation to Our Lady’s Hospital Navan, the CEO advised the Board that he will finalise the response to the Department regarding the latest update received from the Working Group, and will bring the final decision to the Board at a later meeting.

The Board welcomed the planned publication of an Internal Audit in respect of Scoliosis funding at CHI, which had been reviewed by the Audit and Risk Committee.

The CEO provided an update in relation to the regional engagement with Section 38 agencies, which is continuing and that a more proactive management of the relationship is planned at Regional level from 2025. He advised the Board that a workshop with Voluntary Organisations to discuss partnership arrangements is scheduled for 06 December 2024. The Board discussed funding challenges and sustainability in relation to the Section 38 agencies. The CEO advised that he approved proposals on cash management to the end of 2024, which would be notified to the REOs for communication to the wider system. This included an additional €200m allocation of cash accelerations to voluntary agencies beyond the Revised Final Cash Limits notified at the end of October. This additional allocation followed an intensive process of engagement with voluntary agencies on cash management efforts, which had been reviewed and validated by the Regional Finance teams.

The responsibility for the programme of Organisational Change will transfer to the portfolio of the CTTO / Deputy CEO, following the retirement of the National Director for Organisational Change, Liam Woods in December 2024.

The CEO advised the Board of the Public Appointments Service recommendation on the appointment of a Director to the position for Major Capital Infrastructure and noted that the preferred candidate is currently being processed.

An update was provided to the Board in relation to the progress on the implementation of Digital for Care 2030.

Board Strategic Scorecard

The Board noted that all scorecards maintained their rating, except two scorecards, #7 Reform of Disability Services #19 Women’s Health, which reported a downgrade in their rating from 4 to a 3. . The Board approved the Board Strategic Scorecard for November 2024, reflecting September 2024 data, for submission to the Minister for Health, and Department of Children, Equality, Disability, Integration and Youth.

5.1 Contracts and Properties

As recommended by the Audit & Risk Committee for approval, the Board considered and approved the following proposed contracts and properties:

1. 1. 1. National Maternity Hospital at St. Vincent’s University Hospital (NMH at SVUH) – Approval to award contract to carry out further site preparation and enabling work under a ‘Single Operator Framework’ - Decision No.: 291124/51
      2. Contract Award for 90 Bed Community Nursing Unit with Rehabilitation Unit & Dementia Unit at Carrick on Shannon, Co. Leitrim - Decision No.: 291124/52
      3. Acquisition of Sherwood House, 2-3 Sherwood Avenue, Taylors Hill, Galway - Decision No.: 291124/53
      4. Acquisition of Cedar House, Moneen road, Castlebar, Co. Mayo - Decision No.: 291124/54

AND Child and Youth Mental Health Office, AND HSE National Office for Suicide Prevention, Clinical Lead for Youth Mental Health, and National Clinical Adviser and Group Lead for Mental Health joined the meeting

6.1 Mental Health Services, including CAMHS

The National Director Access and Integration introduced the AND Child and Youth Mental Health Office, AND HSE National Office for Suicide Prevention, Clinical Lead for Youth Mental Health and the National Clinical Adviser and Group Lead for Mental Health to the meeting.

Documentation was circulated in advance of the meeting which outlined the HSE’s overall objective to ensure people who are experiencing mental health difficulties have access to supports of varying intensity to match their needs at any point in their recovery journey.

An update was provided to the Board in relation to the overview of mental health services and 2024 performance; Policy landscape & Child and Youth Mental Health Action Plan; Suicide prevention; and challenges and enablers.

The Board noted that the continued development of mental health services is directed by national mental health policy as outlined in Connecting for Life (2015), Sharing the Vision (2020) and in line with the Slaíntecare reform programme. The continued improvement of child and youth mental health services remains a key priority, with a three-year action plan developed for the HSE’s Child and Youth Mental Health Office, which sets out a roadmap to ensure all children and families have equitable and timely access to high-quality mental health services, and the 16 priority improvement themes identified in the plan.

The Board discussed the number of factors that influence the continued development of mental health services, including the growth in service demand, recruitment and retention of staff, infrastructural deficits and the establishment of Health Regions.

The Board noted the increased demand for mental health services, with a 26.8% increase in CAMHS referrals and 12.5% in Adult referrals since 2019, and that the current CAMHS waiting list, as of September 2024, stands at 3341 down from a high of 4293 in 2023. The Board emphasised the need to ensure improvements to service delivery and that every effort is made to prioritise urgent cases so that the referrals of young people with high-risk presentations are addressed as soon as possible.

An update was provided in relation to the work programme and current priorities of the National Office for Suicide Prevention, and the national strategy Connecting for Life. The Board discussed the current priorities including the social and commercial determinants of health in the context of suicide prevention; the improvement of data associated with suicide in Ireland; and planning for a successor suicide prevention strategy.

The Board highlighted the challenges relating to the recruitment and retention of staff, noting that mental health staffing had decreased by 187 WTE in 2024, and were advised that the HSE has been proactive in addressing these issues, including by funding additional training capacity.

The Board discussed access to physical and digital infrastructure which are also presenting particular challenges, and noted the establishment of a Capital Planning Group for Mental Health, with engagement with each Health Region in the development of a multi-annual capital investment plan for all mental health services.

The Board highlighted that access to a fit for purpose digital infrastructure is fundamental to ensuring an integrated service user journey, and to ensure the most efficient use of available resources.

With the establishment of the Health Regions the Board noted that it presented an opportunity to further integrate services at the point of delivery, including through ‘single points of access’, integrated care pathways and shared care arrangements.

The Board welcomed the update and emphasised the importance for the promotion of positive mental health and mental wellbeing across the population and throughout the lifespan of need. And that integrated care, service continuity and the best possible outcomes for those experiencing mental health difficulties to ensure that services are provided within a stepped-care model where each person can access a range of options of varying intensity to match their needs is required.

SLT left the meeting

There was no further business.

The meeting concluded at 1.15pm.