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;
- Waiting lists, a discussion was held later in the meeting.
- Meeting with the Minister for Health planned for next week.
1.4 Ministerial Correspondence
The Board noted correspondence received relating to:
Patient Safety Bill 2019
- 6 September – Minister to Chair
- 19 August- Chair to Minister
- 29 July – Minister to Chair
- 14 July – Minister to Chair
- 27 June – Chair to Minister
First quarter review of the NSP
- 29 July 2022 – Minister to Chair
Owenacurra
- • 16 September – Joint Committee on Health to Chair
- • 31 August- Chair to Joint Committee on Public Petitions
- • 18 August - Joint Committee on Public Petitions to Chair
- • 16 August – Chair to Joint Committee on Public Petitions
- • 16 August – Chair to Joint Committee on Health Our Lady’s Hospital Navan
- • 26 August – Chair to Minister
1.5 Minutes of Board meeting
The minutes from the Board meetings of 27 July 2022 and 2 September 2022 were approved.
Committee Update
Members of the EMT joined the meeting.
2.1 Audit and Risk Committee
The minutes of the Committee meeting of 20 July 2022 were noted. The Chairperson of the Committee advised that Michelle O’Sullivan has joined the Committee and attended her first meeting. He then provided a verbal report on the matters considered at the Committee meeting that took place on 16 September 2022: Accounting, Governance and Financial Reporting, Risk Management, Legal Services, Internal Audit and Estates Management.
The Chair advised that the Head of Legal Services presented a report on Strategic Legal Cases for Q1 & Q2 2022. The Chair reported that an update was provided by ND IA on Quarter 2 Internal Audit cases. ND IA is shortly due to provide a separate paper which incorporates all outstanding recommendations for 2020 / 2021 which is to be brought back to the ARC, who may seek to hear explanations from the accountable management as to reasons for the delay in implementation. The Internal Audit’s Review of funded agencies audit approach was discussed. The Chair advised that the final report from the HSE Property Insurance audit plan 2020 issued on 15th July 2022 with an ‘unsatisfactory’ opinion and the Committee had reviewed some of the mitigation steps undertaken by management. The CSO and ND & AND Capital and Estates presented the current draft of the HSE Capital & Estates Strategy. In relation to Owenacurra, the Chairperson updated the Board on an information note provided by HSE Estates and that the Committee was provided with information and assurances from management with regards to the management of any conflict of interest issues that arose. In respect of the issue of under utilisation of acquired properties it was requested that a ‘lessons learnt’ (including corrective actions) process be carried out and documented by Estates.
2.2 People & Culture
The Chair of the Committee advised of new Committee members. The Chair requested that the Board approve the reappointment of Ms Bernie O’Reilly as external members of the Committee for two years until September 2024. Board Decision No: 300922/69.
The Chair provided updates on Communications, HR Bi-Monthly Report, a Deep-Dive Report on ‘Delivery of Change’ and Risk Management. She advised that new KPIs will be added to the Dashboard next year. The Chair advised that she attended the Health Service Excellence Awards in Farmleigh House on Thursday 15th September 2022 and commented on the many positive projects which are being rolled out across the HSE. The Committee discussed the importance of recruitment and the working group set up by the Minister to enable the recruitment of Non-Consultant Hospital Doctors.
ND HR provided an update on Non-Consultant Hospital Doctors, Rostering, Taskforce, Administration and Recruitment to Year End.
It was advised that work has been done to integrate graduates into integrated care posts. A discussion was had about the retention of graduates. Figures for the three years preceding Covid were requested, in order to gain an accurate picture of the number of graduates who accept contracts. It was observed that there was no travel permitted during Covid and that for this reason, the figures for these years would be inaccurate.
2.3 Safety & Quality
The minutes of the Committee meeting of 12 July 2022 and the September 2022 Quality Profile were noted.
The Chairperson of the Committee provided updates on the following items, as were discussed in the meeting of 13th September: Paediatric Model of Care, Quality Profile, Foetal Alcohol Spectrum Disorder, Internal Audit Recommendation, the CCO Report, Response to the Mental Health Commission Annual Report, Risk Management and Surgery. It was advised that a deep dive of the Paediatric Model of Care system was portrayed by means of a video with a life-long renal care patient, which was very well received.
The Chair advised that the Committee considered the Quality Profile data from the July data cycle. She advised that a workshop is planned in October with members of the Operations team to devise plans for improvement in this area. The Chair advised that ND Strategy and Research presented a position paper on, “Prevention of Fetal Alcohol Spectrum Disorders (FASD).
The Chair provided a summary of the Chief Clinical Officer’s report, specifically in relation to the National Screening Service, ongoing safety risks in Our Lady’s Hospital Navan, Letterkenny University Hospital and Transgender Services. She reported that all but one of the recommendations made by Gabriel Scally have been implemented and the CCO was due to meet the representatives of the 221 Group in Dublin on 19th September. The Chair advised that the CCO also provided an update on National Service Plan priorities for 2023.
The Chair advised that the Committee received an update on the proposed response to the Mental Health Commission Annual Report. The COO advised that the HSE need to liaise with the regulator on an ongoing basis to develop a longer term plan around compliance.
The Chair reported that the ‘go live’ date for the full commencement of the Assisted Decision-Making Act 2015 is November 21st 2022. She advised that the process to move the Bill through the Seanad will begin on 15th September.
2.4 Performance and Delivery
The minutes of the Committee meeting of 22 July and Special Meeting regarding Estimates of 30 August 2022 were noted.
The Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 23 September 2022, which included discussions relating to: Performance Oversight, NSP Planning Process, Committee Focus Area and Corporate Risk Register.
The Chair advised that the Committee are re-working the Terms of Reference and that they will revise the Committee’s approach to its work. He observed that there are three issues of concern to the Committee: labelling and language in the HSE, bed numbers and enhancing and integrating services for older people.
The Chair briefed the Board on the Committees discussion on bed capacity and the area of ‘enhancing and integrating services for older people’. He highlighted concerns about care in the community. The COO advised that there are a lot of ground-level initiatives ongoing in this area
2.5 Technology and Transformation Committee
The Committee Chair advised the Board that the Terms of Reference for the Committee have been approved in the earlier private session of the Board – subject to two changes (i) that the documents reflects the role of the Board ARC in allocating oversight of risks to board committees and (ii) that, notwithstanding the considerable technological expertise of the committee, that the allocation of oversight of broader scale non IT-led transformation projects (such as RHAs) remain within the discretion of the collective Board. He advised that the Committee will meet in October and liaise with the CSO and CTTO to share a plan for discussion.
The Chair advised of the appointments of Rosaleen Killalea, Barry Lowry and Martin McCormack to join the Technology and Transformation Committee for a period of three years, and was approved by the Board. Decision No: 300922/70
The Committee Chair also advised the Board of a press query around the Technology and Transformation Committee and that a draft response is to be circulated.
Break at 11.55am for 15 minutes
Chief Executive Officers Update
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.
Reserved Functions of the Board
4.1 Property Transactions
The CSO presented the following properties for the Board’s consideration and approval.
Properties:
i. Transfer of Property 3 Tivoli Terrace, Clonmel, Co. Tipperary to Tipperary County Council for a nominal fee. Decision No.: 300922/61
ii. Transfer of Property at 7 O’Neill Street, Clonmel, Co Tipperary to Tipperary County Council for a nominal fee. Decision No.: 300922/62
iii. Transfer of three properties to Sophia Housing Association Decision No.: 300922/63
iv. Proposed granting of 10-year lease for property at Barrington Court, Prosperous, Co Kildare to Stewarts Care Ltd. Decision No.: 300922/64
v. Proposed granting of a lease for 9-years 9-months at Old Dispensary, Kilcullen, Co. Kildare to Teach na Daoine Community group. Decision No.: 300922/65
vi. Transfer of HSE Louisberg Health Centre Co. Mayo to Mayo County Council. Decision No.: 300922/66
vii. Proposed Lease of Primary Care Centre at Oriel House, Outrath, Co. Kilkenny for ICPOP team Decision No.: 300922/67
Contract
viii. Contract Award – Outpatients Department (Phase 1) at Merlin Park University Hospital Galway Decision No.: 300922/68
Agreed.
Board Strategic Focus
5.1 Integrated Financial Management & Procurement System (IFMS) – Enabling a high performance organisation; better financial reporting to support quality and value
The CFO and CIO presented to the board a paper which had been circulated prior to the meeting for discussion and information.
The CFO outlined to the Committee that the HSE Corporate Plan (2021-2024) included a number of references to the need for the HSE to make the best use of the resources available to it. The IFMS is the national project, which is delivering a single national finance and procurement system for the publicly funded health and social care service. IFMS is being delivered utilising the latest version of SAP (SAP Hanna) enterprise software, and this business change programme is being supported by technology. In addition to SAP, the HSE has procured IBM to be the systems integrator partner.
The Committee discussed the key challenges outlined in the report to successfully implement the IFMS programme which are the scale and complexity of necessary change; the voluntary organisation adoption; the dependencies on other systems and the investment in the wider health system finance organisation.
The Board noted that the deployment of IFMS in the HSE, Section 38 and larger Section 39 organisations is a key enabler of Sláintecare, and is mandated by the Finance Reform Board and has been expressed as a Ministerial Priority in the HSE National Service Plan(s).
The Board discussed the outline of the key performance indicators (KPI’s) and targets.
It was noted that the success of the programme requires continued engagement with the voluntary sector and also public support at DOH, Ministerial and where necessary Government level for the mandate of IFMS, to include the requirement for its adoption by all organisations within scope, including the voluntary sector, and a series of workshops that have been a core part of the key stages of the project.
The Board agreed that the successful development and implementation of IFMS would be a key strategic enabler for our services, facilitating better financial reporting to support decisions and actions around the better management and improvement of the services we deliver to those that rely upon them.
AOB
The Chair thanked Board Members and Management Team members for their time. The meeting concluded at 3.35pm