Governance and Administration
1.1 Board Members Private Discussion
The Chairman welcomed Board members to the meeting and held a private session to consider the agenda and papers for the meeting.
1.2 Declarations of Interest
No conflicts of interest were declared.
1.3 Chairperson’s Remarks
The Chairperson updated the Board on the following matters;
Resignation of CEO, Paul Reid.
The Committee considered the announcement by the CEO of his resignation from the HSE and the process to recruit his successor.
Board & Committee Membership
The Chairman updated the Board in relation to the recruitment process to fill the board vacancy noting an initial review of applications was held on 27 June 2022 with the Public Appointment Service and the Department of Health, and another assessment meeting is due to be held on 6 July 2022.
Technology & Transformation Committee
The Terms of Reference of the Committee as circulated were reviewed and approved, subject to the inclusion of standard provisions in relation to Authority, Scope and other matters.
It was agreed to appoint Mr Tim Hynes as of Chairperson of the Technology & Transformation Committee, with Fergus O’Kelly and Brendan Whelan becoming members of the Committee.
Other Committee matters
With regard to the Performance & Delivery Committee, Brendan Lenihan will step down as a Committee member, and Anne Carrigy has agreed to replace him on the Committee.
Professor Deirdre Madden informed the Board that Dr Chris Luke will be finishing his term on the Safety & Quality Committee shortly and advised the Board discussions are ongoing with potential replacement candidates. She will revert to the Board for approval once discussions are finalised.
1.4 Ministerial Correspondence
The actions taken in relation to the following correspondence received and circulated to Board members were noted:
- Minister for Health to Chairman re Amended Capital Plan 2022 dated 25th May 2022
- Chair to Minister for Health re Our Lady’s Navan dated 27th May 2022
- Chairman to Minister for Health re national Service Plan Review dated 1st June 2022
- Minister for Health to Chairman re Revised Letter of Determination dated 15th June 2022
- Chair to Minister of Health re Patient Safety Bill 2019 Committee Stage Debate 27th June 2022
The Chairman, Dr Sarah McLoughlin, and Professor Deirdre Madden will follow up with Professor Bernie Hannigan, Chair of Health Research Board in relation to correspondence received.
1.5 Minutes of Board meeting
The minutes from the Board meeting 27 May 2022 were approved.
1.6 Discussion with CEO
The CEO joined the meeting
CEO resignation
The Board discussed with the CEO his recent decision to step down as CEO of the HSE later this year.
Paying tribute to the CEO the Board noted he had led the health service through what has been the greatest challenge it has ever faced and thanked him for his relentless dedication and professionalism.
Reconfiguration of Our Lady’s Hospital Navan (OLHN)
The Board also reviewed with the CEO the progress being made with the reconfiguration of Our Lady’s Hospital Navan (OLHN).
(i) Briefing to the Board on 21st June, 2022 A briefing had been provided to the Board on 21st June, 2022 on the engagements that have taken place with the Minister for Health, Oireachtas members and Clinicians following the Board decision at its May meeting to progress the reconfiguration.
A briefing with the Minister and Oireachtas members from the Meath area took place on 13 June 2022 where a presentation was provided outlining the reconfiguration of Our Lady’s Hospital Navan and elected representatives expressed their views.
The Minister met clinicians at Our Lady of Lourdes (OLOL) Hospital Drogheda on 9 June 2022 where the clinicians expressed concerns about the impact reconfiguration would have at OLOL in terms of additional attendances and the patient safety implications, The Minister received a letter on 22 June 2022 from clinicians in Our Lady of Lourdes Hospital Drogheda outlining their concerns.
It was confirmed at the briefing in June, that the planned reconfiguration of services would proceed in September 2022.
(ii) Current update re OLHN reconfiguration. The CEO updated the Board further on the engagements and the work that is continuing in order to progress the reconfiguration of services at Our Lady’s Hospital Navan.
The CEO informed the Board the Minister may write requesting a review of a number of matters prior to the reconfiguration of Our Lady's Navan A&E to a Medical Assessment Unit (MAU) and the transfer of ICU capacity to Our Lady of Lourdes, Drogheda arising from the concerns expressed by Clinicians in OLOL. The letter from the clinicians at OLOL will be circulated to the Board.
Following the discussion, the Board confirmed its decision to proceed with the planned reconfiguration of Our Lady’s Hospital Navan given the significant and serious patient safety concerns. It was re-affirmed that the planned reconfiguration of services would proceed in September 2022.
Any correspondence from the Minister on the matter will be considered if received.
Committee Update
Members of the EMT joined the meeting.
2.1 Audit and Risk Committee
The minutes of the Committee meeting of 12 May & 24 May 2022 were noted.
The Vice Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 16 June 2022, which included discussions relating to:
- Control environment and noted improvement year on year;
- Corporate Procurement Plan;
- Q1 IA Audit Report presented by Interim ND IA, which outlined a number of interesting audits.
- Risk Management, 2 Risks discussed, Ukraine risk assessment and the impact on health services to which feedback was provided to the CRO; and the ongoing Risk Management process in relation to the Reconfiguration of Our Lady’s Hospital Navan.
- A number of properties, 8 in total were presented, 7 of which were endorsed by the Committee for Board approval and would be discussed later in the meeting. One property required further assurances and the Vice Chair is liaising with ND Estates.
- Contract in relation to IFMS, which was endorsed by the Committee for Board approval and would be discussed later in the meeting.
- Discussion on Re-Allocation of Capital Funding, which the Vice Chair requested the ND Estates update the Board later at the meeting.
- Arrangements for revised and more detailed reporting to the Committee on strategic legal matters.
2.2 People & Culture
The minutes of the Committee meeting of 8 April were noted.
The Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 10 June 2022. A presentation was given by the Head of Internal Communications, Emma Finn, which the Committee welcomed and the Chairperson advised that a discussion took place in relation to how the communications will be managed in relation to the Regional Health Areas (RHA’s).
The Committee had considered the monthly report from National HR Ms Anne Marie Hoey, which reported progress with priorities in relation to the HSE Blended Working Policy; Update on the Recruitment Reform & Resourcing (RRR) Programme; Supports for NCHDs; Training Needs Assessment and the need for mandatory training and how it is monitored.
The Committee Chair noted that at the next meeting of the Committee in September, delivery of change in relation to the RHA’s will be presented.
The National HR People and Recruitment Dashboard was presented, to which the Chairperson noted that the absenteeism rate is on a downward trajectory.
2.3 Performance & Delivery
The minutes of the Committee meeting of 20 May 2022 were noted. The Acting Chairperson of the Committee provided a verbal update on the matters considered at the Committee meeting on the 24 June 2022.
Items discussed were Technology and Transformation Programme, the introductions made with Interim CTTO and CISO, and feedback on proposed Terms of Reference. The IFMS Contract which will be discussed later in the meeting. The monthly Performance Oversight reports were considered by the Committee and the Committee discussed how to improve the reporting format for these. He noted the Committee will be arranging and workshop with the COO to discuss future reporting priorities i.e. establish the optimal method of presenting performance information to the Committee.
The Committee conducted a specific review of performance in relation to Disability Services and a presentation was given by Bernard O’Regan, Head of Disability Operations, which outlined very difficult challenges being faced in the services. The Committee agreed that this is an area that requires continued and regular engagement with the National Director of Community Operations and Head of Disability Operations to build Board confidence in the Roadmap that is be produced. It was also agreed that this is required to ensure that it is implemented successfully.
It was suggested that future presentations relating to other services, including mental health, older people along with disability services be included as part of the strategic discussion items on the Board work-plan.
2.4 Safety & Quality
The minutes of the Committee meeting of 10 May were noted. The Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 14 June 2022. She informed the Board that the Committee discussed the Review of the Operations of the National Independent Review Panel, and their considerations and recommendations of the Working Group. A further paper is to be presented to the Committee at a future meeting in July or September 2022.
The Committee considered the HSE Quality Profile for June 2022 and was briefed in relation to Scheduled Care. The Committee was presented with supplementary information in relation to all attendees aged 75 years and over at ED who are discharged or admitted within 6 hours, which is below target.
In consideration of the recommendations of the Scally report, the Committee received a presentation from the National Office of Open Disclosure on its Annual Report. The Committee welcomed the report, noting the challenges during the Covid pandemic due to redeployment and difficulties in communicating other than by way of face-to-face meetings. The Committee also noted that further training would be required in relation to the Patient Safety Bill.
The Committee received a presentation from the National Women’s Council in relation to Improving Health Outcomes and Experiences of the Healthcare System for Marginalised Women, which was also welcomed.
The Committee received an update with regards to Corporate Risk 14 – Sustainability of Screening Services. The Committee were reminded that Screening Services risk remains a long-term red risk and that this would be discussed further at its July meeting.
The Chief Clinical Officer’s Report was discussed by the Committee including matters relating to: Pandemic Response; Update on Ukrainian Crisis; Hepatitis cases in children; Monkeypox; Obstetrics and the Reconfiguration of Our Lady’s Hospital Navan.
Chief Executive Officers Update
The Board reviewed with the CEO and EMT the key aspects from the CEO monthly report and supporting papers, and the Board Strategic Scorecard Report, which had been circulated prior to the meeting.
The Board discussed a number of senior appointments noting that
- Damien McCallion has taken on the role of Chief Operations Officer (COO) on an interim basis and the recruitment process for the COO post has commenced with the hope of securing a suitable candidate by year-end.
- John Ward as Interim CTTO, reporting directly to the CEO and Puneet Sukreja who has taking up the role of Interim CISO, reporting directly to the CTTO. The CEO advised the Board of currently undergoing a recruitment process to fill these roles on a permanent basis by year-end.
- Eileen Whelan has taken on the role as Interim National Director of Vaccination, Testing & Tracing Programmes. The CEO updated the Board in relation to meetings he attended since the last Board meeting. A Cabinet Committee meeting was held on 9 June 2022, to discuss and outline the current status in relation to HSE recruitment targets; waiting lists; emergency department’s current performance and the financial position. Further discussions on these items took place later in the board meeting. The CEO and a number of HSE officials attended the Joint Committee on Disability Matters and Children, Equality, Disability, Integration and Youth.
The CEO updated the Board regarding a meeting requested by the Minister for Health that HSE senior management had attended and advised that he wrote to the Minister outlining a number of concerns in relation to the organisation, attendees and discussion at the meeting.
The Board received an update in relation to the increased attendance at EDs and Covid numbers rising which is resulting in increased pressures noting this will need to be monitored and a judgement call on elective care may be required.
The CEO made reference to the report of HIQA’s inspection of the emergency department at University Hospital Limerick and informed the Board that the ND OPI team are currently working with UHL and HSE Midwest Community Healthcare to implement an action plan to include additional measures to improve patient streaming and hospital avoidance.
The CEO updated the Board on the response to the work ongoing in relation to the data breaches relating to the Cyberattack on the HSE in May 2021, noting that the Minister has written to the Attorney General on the matter. He informed the Board that a Steering Group has been established to propose an Action Plan to address the shortcomings in internal controls in the High Earners Review.
The Board then held a discussion focused on the following areas as addressed in the CEO Report:
Scorecard
The CEO presented the May 2022 Board Strategic Scorecard Report, as circulated prior to the meeting and noted that next months will be the half year report.
The Board discussed the ratings in relation to Key Programmes / Priorities, noting the following:
- The average rating of the 20 scorecards is 3.45, slightly down from last month’s scorecard average rating of 3.50. This is due to changes in the status of 3 scorecards: Prevention and Early Intervention, Infrastructure and Equipment and Enhancing Bed Capacity.
- Individual scorecards that show KPI progress ahead of target include Reform of Primary Care, Community and ECC and Technology and e-Health.
- As part of the engagement with the Department of Health and in line with reporting requirements, a supplemental Appendix to indicate alignment with the 2022 Letter of Determination has been included in the May 2022 Board Strategic Scorecard . Further improvements to highlight alignment are forthcoming.
Following the discussion the Board approved Board Strategic Scorecard Report for submission to the Minister. It was agreed that at the next Board meeting there would be a discussion of the process for determining Scorecard ratings and discussion on alignment of the programme/projects in the scorecard with the Corporate Risk Register.
Vaccination and Test and Trace
The Board discussed the progress with implementation on the future operating model for the Test and Trace Programme to transition from the current mass testing model to a surveillance led model with a GP clinical pathway. The Board noted that the transition plans for the Test & Trace Programme were presented to the Cabinet Sub-Committee where the strategy and overall approach were endorsed.
The Board discussed the surge response model arrangements in the Transition Plan, which will be required as part of the GP pathway in Winter 2022/2023, noting that the surge response will be triggered by an agreed set of criteria such as a surge in the disease in the community or pressure on GP capacity. NAS will provide the first line of response to a surge with up to 200 WTEs providing circa 25,000 per week, at pre agreed site locations around the country. If demand increases further, NAS can be supplemented by private providers to reach capacity of 45,000 swabs per week. In addition, there will be activation of additional laboratory capacity with key partners to accommodate the increased testing demands.
The Board emphasised the need to ensure for a strong communications strategy to manage any surge in the virus, and protect vulnerable people and ensure strong uptake in the Vaccination programme. The CEO confirmed a new Covid 19 Advisory Group has been established by the Department to advise Minister and Government on policy issues and communications.
He noted the Covid 19 Vaccination Programme will continue the administration of the second booster doses to over 65’s and over 12’s immunocompromised up to the end of June, and from July retained vaccination centres and participating pharmacies will continue to provide vaccinations for those choosing to take up their primary dose or secondary booster. Following questions from Board members, the details on the HSE website are to be reviewed to ensure appropriate information is provided. This is in relation to the vulnerable cohort who are to be vaccinated.
Finance
The CFO provided an overview to the Board on the April YTD figures. He noted that the revenue Income & Expenditure (I&E) financial position at the end of April 2022 shows a YTD deficit of €336m or 5.0%, more than 80% of this deficit caused by Covid-19 related costs. Capital I&E is showing a surplus of €39.4m, and Cash payments to end May are ahead of the cash profile by €335m.
Finance Q1 Forecast
The CFO informed the Board that indications from the Q1 Forecast show that there has been a concerning level of unfunded core costs year to date and this trend is currently predicted to continue through 2022. There is also a slower than expected fall off in Covid specific costs in community and hospital given the pattern of the disease over the last few months, and if unchecked will leave many of the services significantly exposed financially as we enter in the Estimates process for 2023. There is real pressure on general Government finances and significant competing demands from across the public sector, which is a very serious matter in this context.
The levels of unfunded costs that are being seen that are likely without action to be carried into 2023 are beyond what was previously expected. Elements of this, such as the re-emergence of strong price inflation pressures, are largely beyond our control but there is a need to take additional steps to ensure that every action to mitigate all unfunded costs is being taken.
Estimates and NSP 2023 Planning Process
The ND S&R presented to the Board the Estimates and the development of the National Service Plan, which outlined the proposed approach to the 2023 Planning Process, which was discussed previously by the Performance & Delivery Committee.
The Board discussed the following considerations which will need to be taken into consideration when finalising the 2023 estimate for expenditure:
- Ministerial priorities, not included in proposals, but could consume a potentially significant proportion of any new funding allocated.
- Significant Government financial pressure arising from additional demands on available public finances, including the need to respond to the War in Ukraine and rising inflationary pressures
- Residual open posts from the 2022 planning process, requiring approximately 6,000+ WTEs in 2023 for recruitment
- Impact of the roll-back of the Haddington Road Agreement and lost service delivery hours
- Rate of turnover of staff (including staff leaving due to emigration etc.) which in 2022 will create a further demand for fresh recruitment in order to stand still
- Lack of guarantee of the retention of Covid-specific funding (e.g. €200m access to care fund)
- Extent to which COVID-19 pandemic responses need to remain in place or be scaled down across hospital and community services
- Requirement to maintain an appropriate level of Test and Trace, Vaccination and Personal Protective Equipment in 2023.
It was agreed a further briefing will be provided at a future Board meeting and there will be on going engagement with the Performance and Delivery Committee.
Corporate Procurement Plan (CPP)
The CFO briefed the Board on the Corporate Procurement Plan (CPP) which set out the key actions required to support the HSE’s objectives to increase the level of procurement compliance, deliver value for money and support the delivery of the Government’s climate action plan.
The Board noted that the ARC reviewed the CPP 2022 at their meeting in June and provided feedback to the CFO, who advised that the Plan circulated to the Board has addressed that feedback. The Board supported the plan for publication.
Reserved Functions of the Board
4.1 Property Transactions
ND Estates presented the following properties for the Board’s consideration and approval.
The V/Chairman of the Audit and Risk Committee (ARC) noted that all property transactions had been considered by the ARC at its monthly meeting and were recommended for approval by the Board.
The Board approved the following 5 properties relating to Primary Care Centres.
- Acquisition of site from Wicklow Co County Council for the development of Greystones Primary Care Centre. PRG ref. E/L/0422/2059 (Decision No: 290622/44)
- Proposed lease for additional accommodation at Primary Care Centre, Station Road, Ennis, Co Clare. PRG ref: MW/L/0522.1989 (Decision No: 290622/45)
- Proposed lease for additional accommodation at Primary Care Centre, Tralee, Co Kerry. PRG Ref: S/L/0322/2662 (Decision No: 290622/46)
- Proposed lease for additional accommodation at Primary Care Centre, Thomastown, Co Kilkenny. PRG ref: SE/L/1221/1443 (Decision No: 290622/47)
- Proposed lease of Primary Care Centre at City West, Garters Lane, Saggart, Co Dublin. PRG ref: E/L/0422/2405 (Decision No: 290622/48)
Proposal for New Emergency Department and Women’s & Children’s Development Block at University Hospital Galway (UHG)
ND Estates presented the Proposal for a New Emergency Department and Women’s & Children’s Development Block at University Hospital Galway (UHG), which the ARC recommended for consideration and approval by the Board. He advised the Board that this proposal was to provide appropriate infrastructure and to enable the required level of service provision at UHG.
The Board approved the Strategic Assessment Report (SAR), for formal submission to the Department of Health for formal review and approval to progress to the Stage 2 (Preliminary Business Case) of the project, which will then be referred to the Board again for endorsement. . (Decision No: 290622/49)
Public Private Partnership (PPP) for the delivery of 7 Community Nursing Units
The ND Estates presented the paper to seek agreement on the approval and logistics process to allow the HSE enter into a Public Private Partnership (PPP) for the delivery of 7 Community Nursing Units. He noted all CNUs included in the PPP bundle provide replacement beds for some of the poorest CNU accommodation currently in operation by the HSE. Most of the facilities being replaced are former workhouses and do not meet the requirements established by HIQA as the regulator.
He informed the Board that while the project is not expected to achieve financial close until August 2022, due to the nature of the PPP arrangement some steps are required in advance of the final approvals (for all parties to the PPP arrangement) to ensure the Project continues to progress. In that context the Board approved the following:
- The form of approval required by the Project Lenders to secure lender consent to finance the Project.
- The arrangements for approving the transaction and signing/sealing of contract documents. (Decision No: 290622/50)
4.2 Contract Transactions
4.2.1 IFMS
The Board considered and approved the Contract Approval Request for IFMS replacement System Integrator (SI), which was circulated prior to the meeting. (Decision No. 290622/51).
The Board noted this contract had previously been considered by the ARC at their meeting of 16 June 2022, and discussed at the Performance & Delivery Committee of 24 June 2022, where both Committees recommended for onward submission to the Board. The additional information requested by the Performance & Delivery Committee, which related to a high level summary of the IFMS Project Risk Management Process, was included in the Board paper.
The CFO provided an update to the Board, outlining the detailed procurement process, noting that it would be necessary in due course for a case to be made to adjust upwards the ICT Capital budget. The capital cost within the Contract Approval Request (CAR) is €59.4m, and the approved ICT capital budget for the project is €82m, with €16.8m incurred to date, and further committed costs that will bring the total costs of the project to exceed the €82m budget. Accordingly, it will be necessary to seek an adjustment sanction from the Departments to the €82m budget.
Re-allocation of funding in the Capital Plan 2022
Discussion took place in relation to paper circulated prior to the meeting to inform the Board on proposals for the re-allocation of funding in the Capital Plan 2022.
The Board supported the re-allocation of funding in the Capital Plan as proposed in the paper circulated prior to the meeting noting his proposal was considered and recommended to the Board by the EMT and the Audit & Risk Committee and had been discussed with and is supported by the Department of Health.
The re allocation of funding is based on the completed Quarter 2 review by management of all major projects and programmes involving an analysis of progress, expenditure to date and projected expenditure across each project against allocation in the 2022 Capital Plan which identified a likely slippage in a number of projects.
ND Estates left the meeting.
Board Strategic Priorities for 2022
5.1 Scheduled Care Transformation Programme
The Board considered the briefing paper, circulated in advance of the meeting, on the Scheduled Care Transformation Programme intended to improve scheduled care to enable more timely access and reduce the number of people waiting for services.
A presentation was given to the Board to provide detail in relation to the 2022 Waiting List Action Plan, which is expected to deliver the 2022 NSP targets and the development of a Multi-annual plan. The CEO informed the Board on the key challenges to addressing the issue of waiting lists, and outlined the approach agreed between the HSE, DoH and Government on this programme of work which included progressing foundational steps to support longer-term reforms, including completing a waiting list Demand and Capacity analysis, which is being used to identify capacity gaps and ensure targeted investment. A concerted focus by the HSE, DoH and NTPF in the final quarter of 2021 against a short-term Action Plan (September – December) also delivered a slight reduction in OPD, IPDC and GI Scope waiting lists.
The Board considered the progress on implementation of the 2022 Waiting List Action Plan (WLAP) which was jointly developed by the HSE, DoH and NTPF with dedicated funding of €350m, including an additional €150m allocated to the NTPF and €200m allocated to the DoH. A Waiting List Task Force, co-chaired by the CEO, Secretary General was established to oversee the delivery of the WLAP and progress is reported monthly to the HSE Board through the Board Strategic Scorecard.
The focus of the Board discussion was on the actions and investment provisions in the WLAP to deliver significant additional activity in 2022 and build recurrent capacity within the system to sustainably address recurrent capacity gaps, to develop and agree a Multi-Annual Waiting List Reduction Plan to support the achievement of Government maximum wait time targets and the scheduled care reform initiatives being taken forward under the 2022 WLAP including
- Patient-Centred Booking Arrangements and Patient Initiated Reviews in order to enhance patient involvement and ensure patients are on the most appropriate pathway
- A strategy for managing ‘Did Not Attends’
- The Health Performance Visualisation Platform system is to introduce a new automated approach to acute hospital information management that will produce timely, meaningful insights and reports for clinicians and managers
- A strategic partnership with the private hospital sector involving the traditional means of purchasing activity and other options such as co-investment, shared risks, and incentives.
The NSP 2022 and WLAP have set out the Maximum Wait Time Targets and the Board were informed of the reductions that been achieved year to date, but despite the reduction, the number of long waiters remains well behind target. Dedicated focus on improvements is required immediately to ensure progress towards the NSP 2022 Maximum Wait Time Targets.
The Board acknowledged that waiting lists have been a challenge for many years and require significant long-term focus and reform. The Board noted that since the beginning of the COVID-19 pandemic (March 2020 – Dec 2021), waiting lists have grown by 8% and emphasised that tackling waiting lists remains as one of six key priorities in the HSE Corporate Plan 2021-2024.
The Board welcomed that detailed plans have been developed to deliver additional activity in 2022, above and beyond core and circa €44m in non-recurrent funding has been approved to date. A further €124m in recurrent funding has been proposed to progress sustainable solutions to address recurrent capacity gaps identified through the Demand and Capacity Analysis and the development of evidence-based models of cares. A number of key reform initiatives are also being progressed in 2022.
AOB
The Chair thanked Board Members and Management Team members for their time. The meeting concluded at 3:30pm.