The Board reviewed and discussed the key aspects of his final CEO monthly report and supporting papers, including the Board Strategic Scorecard Report, which had been circulated prior to the meeting.
The CEO highlighted the following strategic areas of his report to the Board and discussions were held on these areas: Reflections on 2019-2022 ; Strategic Score Card; Role, impact and learning of Confidential Recipient Report; Navan Hospital update; Outcome of Budget 2023.
The CEO advised the Board of his visits to services in Waterford and Kilkenny this month, which were designed and supported by the internal communications team, where he spent the days visiting the patients and staff, met with local political representatives and local media.
An update was given to the Board in relation to the media matter in early September relating to Cervical Check. He also outlined to the Board that the launch of the flu vaccination programme campaign is to take place next Monday 3 October and that the Communication launch to start next week.
He advised the Board of the proposal through the DoH along with UCD by Eileen Whelan in relation to NVRL. The proposal is to establish a dual capacity laboratory for the country. The CEO raised this with An Taoiseach this week who was highly supportive and intends to bring to Government.
An update was provided in relation to the National Ambulance Services (NAS) development of a tenyear strategy (2022-2031) with an emphasis on the continued development of alternative care pathways, specialist paramedic roles and progress towards meeting capacity and organisational development improvements. The NAS Strategy will be submitted to the Department of Health who have indicated that the Minister intends to bring a Memo to Government seeking support for a 10-year programme of investment and, subsequently, wishes to launch the Strategy. It is intended that feedback on the draft strategy will be sought from the Performance & Delivery Committee prior to its finalisation and approval by the Board before it proceeds to the Minister.
A discussion was held in relation to the Reconfiguration of services at Our Lady’s Hospital Navan, and referred to the briefing paper that was put forward by the Working Group, which was circulated prior to the meeting. The Board noted that the report’s objectives as set out in the Terms of Reference for the review were agreed with the Minister and the DoH. The recommendation that arises from the near final draft of the review is to proceed with the reconfiguration of OLHN to a Model 2 hospital based on the reconfiguration plan that has been put forward by the Working Group.
This recommendation is based on the view that this will provide patients with the highest quality, safest service. Mitigations have been put in place to manage the risk of higher volumes of displaced activity. In addition, the most critically unwell patients will be expedited for treatment within the ED at OLOL and will be provided with high quality clinical care. On balance, the review has indicated that proceeding with reconfiguration and implementing the plans developed will provide patients in the catchment area with the best care.
The expected timelines for implementing this reconfiguration will be reported to the Board next week when the finalised copy of the review will be presented to the Board. The Chairman will write to the Minister enclosing the reports and the HSE’s position on same. Board members indicated that the Chair should signal to the Minister that it wished to discuss the reconfiguration at its meeting with the Minister on October 6th.
An update on Human Monkeypox (MPX) cases was supplied to the Board. The CEO outlined the need to strengthen public health and clinical responses to stop transmission and emphasise the importance of engagement with affected communities. He advised that a governance structure has been established, in the form of a Crisis Management Team (CMT) chaired by an Assistant National Director, Acute Operations.
National Genetics and Genomics Strategy
The CEO advised the Board that there has been extensive public interest in the development and enhancement of genetics and genomics services in Ireland. A Steering Group has been established chaired by an expert in this area, Dr Mark Bale. The Steering Group has established the guiding principles, vision and objectives for the Strategy and developed a bid for New Service Development funding under Estimates 2023. A town hall meeting is to be held on the 30th of September where Working Group leads will present the key priorities to genetics and genomics participants, which will provide an open and transparent platform from which participants can raise questions on all priorities. Dr Colm Henry has also attended a briefing with the Minister for Health on the subject.
Regional Health Areas (RHAs)
The CEO provided an update to the Board stating that significant work continues on the planning for the introduction of Regional Health Areas, led by the HSE and DoH officials. There is work on the development of an agreed service delivery model for the health and social care system, setting out roles and responsibilities at a high-level for the HSE Centre (and Department) and the RHAs. This model is being considered by senior HSE staff working with Departmental colleagues. In the coming weeks, the emerging model will be shared with the HSE Board for consideration and further refinement.
During September there has been significant engagement with CHO and Hospital Group staff through six regional events (in Cork, Limerick, Sligo, Kilkenny, Tullamore and Dublin), and also a constructive meeting between senior HSE and Departmental officials and the Voluntary Dialogue Forum.
The Board held a discussion and outlined their concerns in relation to the Scorecard rating of 4 for RHA’s on the Board Strategic Score Card It was agreed that the rating should be amended to a 3 and a further update will be provided in relation to timelines and implementation plan at the next Board meeting.
Cyber Security
The CEO advised that the CTTO is on leave at present, but provided an update in relation to the Cyber Security Strategy. He outlined that some funding has been received, and the CIO has put forward a request in the Estimates.
The CEO updated the Board on political meetings that he and HSE officials attended, the Joint Committee on Health and the Public Accounts Committee. He stated that overall there was good engagement.
Confidential Recipient
J P Nolan, Head of Quality & Patient Safety (QPS), Dr Orla Healy, National Clinical Director Quality and Patient Safety and Leigh Gath Confidential Recipient (CF) joined the meeting.
The Head of Quality & Patient Safety presented to the Board a paper and welcomed Ms Leigh Gath, Confidential Recipient to the meeting.
They outlined to the Board the establishment and purpose and operation per protocol of the Confidential Recipient (CR). The CR has been operating since 2015 for handling concerns raised by any individual in relation to the provision of services to people with a disability, and has expanded its remit to take confidential receipt of concerns from people regarding older persons and mental health services. At Q4 2021, 97.5% of the 1216 cases received had been successfully closed.
The Board considered the report and held a lengthy discussion with the CR in relation to the dominant themes in cases which included staff behaviour, access to services, placements and eligibility. It was noted that there are a range of learning points from these cases which can improve how disability and other services are funded, configured and provided to improve person centeredness and the following recommendations were made by the Community Operations for which the board to endorsed:
- The terms of reference for placement and eligibility committee in CHOs will be reviewed and the incoming Confidential Recipient will play an active role in this process.
- A meaningful disability service user engagement strategy will be developed facilitating service user involvement in service design, with sufficient agility to gather the view of people with a range of disabilities
- Building on the success of the inpatient acute hospital patient experience survey jointly administered by HIQA, the HSE and Department of Health – Community Operations will seek to establish an equivalent for disability services and will engage with HIQA on this.
A discussion took place in relation to the recommendation by the current CR to the Board for their consideration in relation to the relocation of the reporting line of the CR from directly to the CEO to the National Clinical Director of Patient Safety be reconsidered to maintain independence of the role. The Board agreed and it was noted that the CR will continue to have access to the Safety & Quality Committee.
Budget
The Chief Financial Officer (CFO) provided an early briefing to the Board on Budget 2023 following Budget day announcements on 27th September 2022. It was noted that significant analysis and engagement with DoH colleagues was required over the coming weeks in advance of receipt of the Letter of Determination from the Department of Health which is expected to be received no later than 18th October 2022 with the HSE National Service Plan due to be submitted to the Minister within 21 calendar days thereafter. There was a high level discussion focused on the existing level of service issue and also on new service developments and the funding level and methodology for same.
3.2 Waiting Lists
The CEO advised that the Minister has requested a meeting in the week commencing 3rd October to discuss the implementation of the Corporate Plan. The plan was devised in 2022 and is committed to delivering substantial reductions in waiting lists and waiting times, working towards achieving the Sláintecare maximum wait time targets by 2026.
A discussion was had about how to prepare for increased hospitalisations over the winter period. ND Acutes outlined our position in Quarter 2 in relation to the WlAP targets and explained the factors that have impacted this. She advised that an action plan has been developed in order to target these actions. Finally, ND Acutes provided details of the performance against NSP targets set, this data representing performance up as far as August this year.
Forecasting models were discussed. Regarding repurposing space, it was agreed that care and non-scheduled care need to be separated.
A discussion was had about the DoH’s initiative to have joint working groups and how this can interfere with existing initiatives that the HSE has in place, to solve departmental issues.