The CEO and members of the EMT joined the meeting.
The Chairman informed the Board that the preparation of the Estimates incorporates two elements: an estimate of funding requirements for an Existing Level of Service (ELS) for 2023 (led by National Finance) and an estimate of requirements for key New Service Developments (NSDs) for 2023 (led by the CSO).
The Chairman invited the CEO and CFO to provide an overview of the paper setting out the estimated financial cost in 2023 for ELS which had been circulated to the Board prior to the meeting for review and consideration.
The CFO briefed the Board on the 2022 forecasted deficit and the 2023 financial estimates for ELS.
He informed the Board that the planning and decision making for 2023 had considered results from a ‘bottom up’ approach to determining ELS needs, the prioritisation of NSDs that aimed to optimise and ‘future-proof’ front-line service delivery, and the evaluation of COVID-19 related service implications during a transition from pandemic to endemic state and commitments to ensure ongoing system resilience against cyber-attacks, building on lessons learned from the most recent cyber-attack.
The CFO outlined the 2023 total estimates figure required of €5,061 billion and brought the Board through the breakdown. ELS 2022 & 2023 figure of €3,491.8m (17.5% of 2022 budget), broken down into 2023 ELS Core of €2,499.3m + €992.5m 2022 gross deficit. There will be an expected requirement of up to €971m in 2023 in relation to COVID-19. NSDs figure of €509.7m which includes €294.90m (1,275 WTE) for operational requirements and, €138.84m (1,062 WTE) for key service delivery enablers. Cyber-security implications required is €88.5m (of which €19.2m is capital).
He informed the Board, the latest HR assessment of recruitment is projecting a minimum overhang of 4,494 WTEs into 2023 as the maximum recruitment possible in 2023 is 6,010 WTEs. This means that there is scope to seek funding for and recruit an additional 1,500 posts in 2023 while remaining within overall recruitment targets.
The Board were then presented with an overview of the Estimates for NSDs in 2023 by the CSO who presented the key messages from the briefing papers circulated prior to the meeting. He provided an estimate of requirements for key NSDs for 2023 under two broad categories that reflect requirements related to Operational Service Delivery and Strategic, Clinical and Corporate Enablers.
The CSO informed the Board that the focus is on full implementation of all strategic developments and service improvements funded in previous years, and to identify exceptional areas where targeted investments are required in 2023, and where there is an assured supply of the requisite staff categories.
The CSO brought the Board through a summary NSD list, which was produced following several iterative reviews and prioritisation of individual NSD submissions across different organisational areas. He noted that the aim of the NSDs estimates is to ensure submissions would reflect both current realities and strategic alignment with a link to high value, high impact results.
The Chairman of the Performance and Delivery Committee reported that the Committee had reviewed these papers for ELS and NSD funding at its meeting on 30th August 2022 and had emphasized the need for clear communication and open engagement with the DoH and DPER to ensure the primary deficit driving factors for the 2022 Core Gross Deficits are understood as financial risks which had been highlighted in the HSE Service Plan this year.
The Board reviewed the factors driving the ELS 2022 core deficit of 17.5%. These include Financial Emergency Measures in the Public Interest (FEMPI); Winter Flu; loss of Acute Private Income; Acute Gross Costs; Public Community Nursing Home Costs; Ukrainian Response; Non-Pay Inflation; Haddington Road Agreement; Pensions, PCRS and other demand leads; Disability Operations; Clinical and Operation Services.
The Board noted discussion is ongoing with Government regarding a Supplementary Estimate to address aspects of the core deficit highlighted as financial risks in the HSE Service Plan which would have happened in previous years.
The Board noted the ELS estimate costs pose significant challenges in the face of current Exchequer financial and recruitment/retention realities and require further rationalisation in the coming days, cognisant of the forecast 2022 circa 4,500 WTE recruitment overhang.
The Board considered the challenges in preparation of the Estimates 2023 noting it is more complex than in previous years, given financial pressures on government, residual challenges around recruitment and retention and the broader ongoing impact of the pandemic. The Board also considered how expected inflationary pressures will materially impact the economy overall with direct effect on direct and indirect service provision next year.
Following the discussion, the Board noted the preliminary view of Estimates (ELS) 2023 and NSD has been shared with the DoH in order to allow a more informed process leading up to budget day 2022.
The CFO then provided an outline of the prioritisation exercise that will be undertaken over the coming days to present the DoH with options to narrow the gap and ensure fully informed, collaborative decision-making towards final commitments for 2023.