HSE board meeting minutes 31 May 2023

A meeting of the Board of the Health Service Executive was held on Wednesday 31 May 2023 at 9:00am in the Boardroom, Dr Steevens’ Hospital.

Present:

Mr Ciarán Devane (Chairperson), Mr Brendan Whelan, Mr Aogán Ó Fearghaíl, Mr Fergus Finlay, Prof Fergus O’Kelly, Mr Tim Hynes, Dr Yvonne Traynor, Ms Michelle O’Sullivan and Mr Matt Walsh

Remotely:

Prof Deirdre Madden, Dr Sarah McLoughlin and Ms Anne Carrigy

In Attendance for Board Meeting:

Mr Bernard Gloster (CEO), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Office of the Board)

Joined the meeting:

Mr Roderic O’Gorman (Minister for Children, Equality, Disability, Integration and Youth), Ms Anne Rabbitte (Minister for Disabilities), Mr Kevin McCarthy (Secretary General), Mr Colm Ó Conaill (Assistant Secretary General) and Mr Eoin Wilson (Special Advisor to Minister for CEDIY)(Item 4.2), Ms Anne Marie Hoey (ND HR), Mr Gary Holohan and Ms Yvonne Mowlds (PWC)(Item 5)

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 Board members to the meeting and held a private session to consider the agenda and papers for the meeting.

1.1 Declarations of Interest

No conflicts of interest were declared.

1.2 Chairperson’s Remarks

The Board welcomed newly appointed board member Matt Walsh to the meeting.

The Chairperson provided an update to the Board during their private session on number of matters. He noted the release of the audit certificate by the C&AG is awaited. This will enable the formal submission of the Annual Financial Statements to the Minister.

He also noted that correspondence had been received by the CEO from the Department of Health (DoH) seeking the HSE input to the development of the DoH Statement of Strategy 2023 - 2025.

At the Board meeting of 26 April 2023, the Board held a discussion regarding the Capital Plan 2023 (Building and Equipment), which had been approved by the Board at its meeting of 24 March 2023 and thereafter submitted to the Minister for Health.

The Plan was approved by the Minister however some subsequent changes to this were requested by the Department of Health. The CEO was satisfied these were relatively minor and the updated plan was circulated via email to the Board, which was approved. Board Decision No.: 260423/27

1.3 Minutes of Board meeting

The Board approved the following minutes: - Minutes of Monthly Board meeting 26 April 2023 - Minutes of Special Board meeting re AFS 23 May 2023

2.1 CEO Report

The CEO Report was taken as read. The CEO reported to the Board on a number of the key significant areas as set out in the report.

In particular, discussions were held on the following aspects of the report.

Enhance primary and community services and reduce the need for people to attend hospital

The CEO informed the Board that the reform of Primary Care and specifically the building of the Enhanced Community Care (ECC) programme is progressing positively and that substantial progress that has been made despite the influence of the pandemic.

He noted that ECC has had substantial investment and is now starting to yield results. ICT and Recruitment are impacting overall program effectiveness, but all have mitigation plans in place. He informed the Board that a specific requirement has been set for September 2023 for the ECC model to provide an interface with both public and private nursing homes to improve hospital avoidance and to support post hospital discharge.

The Board welcomed this update noting the ECC programme demonstrates a significant opportunity for the future by providing the foundation and organisation structure through which integrated care is being enhanced. The Board welcomed the focus on implementing an end-to-end care pathway that provides care for people at home and over time prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so. The Board discussed the importance of delivering the ECC programme to reorient service delivery towards general practice, primary care and community - based services.

Improve scheduled care to enable more timely access and reduce the number of people waiting for services

An update on performance in relation to scheduled care was provided, the CEO noted that while new referrals are ahead of expected demand the HSE has also been able to respond ahead of planned activity and this has mitigated the impact of the extra additions. He noted overall National Service Plan (NSP) target position on waiting list in terms of waiting times shows only a minor variation from target. The CEO informed the Board that a review of the projections and robustness of the planning data for Emergency Department projections is currently being carried out and he will report further on this matter in due course.

In response to questions from Board members on the development of surgical hubs and elective hospitals the CEO informed them that the completion of business cases for two sites is expected to be finalised in October 2023. The Board sought an update regarding early intervention for children with Scoliosis and the CEO undertook to circulate a briefing note on the up-to-date position to Board members on this.

Prioritise early interventions and improve access to person-centred mental health services

While noting that many aspects of the responses to mental health services are very positive, the CEO confirmed that the reform of mental health services as a delivery system is most challenged in the area of CAMHS, which the CEO has previously reported to the Board.

He noted that he met with the Chief Inspector of the Mental Health Commission (MHC) and that the MHC reported good co-operation from the HSE in regard to a MHC report which is due to be published in July. He advised, however, that it is expected that the report will set out a number of significant observations for childrens services in the areas of consistency of approach, lack of integrated service delivery, waiting lists, leadership and a more positive observation of more monitoring leading to decreased risk.

Urgent Care Challenges (including June Bank Holiday Weekend)

The Board considered the continued service challenges in respect of urgent care and noted that the upcoming bank holiday weekend could result in the service being put into a very difficult position. In an aim to plan and support the system during the bank holiday period the CEO informed the Board that he had made a direct intervention with the operational system to develop an approach to the challenge. The Board were briefed on the ongoing engagement between the DoH and the HSE regarding workforce reform rostering services including proposals for a 5 / 7 rostering service. The CEO has had discussions with the Minister and the Secretary General to advance very detailed proposals in the coming three to four weeks to ensure a key element going into the next round of the public sector pay talks is to ensure that the health system has capacity to recruit and deploy on a 5 / 7 basis for every grade employed in the health service.

The CEO noted that it is the HSE’s intention for the health service to operate routinely on a 5 / 7 as opposed to a 5 / 5 and on-call basis. It is necessary to have the healthcare workforce, including management, allied health professionals, community nurses operating as a team and across multiple services in both acutes and community.

Safeguarding

The CEO informed the Board he has commenced discussions on the understanding of, and by the organisation, in regard to all aspects of safeguarding reporting and will revert to the Board on this in due course. He also agreed to liaise with the Chair of the Safety and Quality Committee regarding a recent NiRP Report.

National Screening Services

The Board were informed that the Coombe Hospital continue to pause HPV and cytology sample processing for Cervical Check pending conclusion of the accreditation process by the Irish National Accreditation Board (INAB). The Board were informed that with sample processing at the Coombe Hospital currently paused, all Cervical Check samples are being tested in Quest Diagnostics Inc. in the US.

The Board sought a time-bound plan for the conclusion of the matter and the CEO agreed to revert to the Board on this.

Reconfiguration of services at Our Lady’s Hospital Navan

The Board requested an update on the current position in respect of the reconfiguration of services at Our Lady’s Hospital Navan. The CEO agreed to follow up with the CCO and revert on this matter to the Chair of the Safety and Quality Committee.

Finance and Human Resource Management

The CEO noted that the financial position remains as indicated and discussed at the April Board meeting. He advised that the draft expenditure data indicates a deficit for the first three months of the year of €178m, signalling expenditure pressures, albeit these are lower than flagged in the NSP. He advised that there remains expenditure risks this year, particularly in Acutes.

The Department of Health and the HSE continue to work proactively to mitigate the financial risks in 2023. The CEO informed members of the Board that he has taken some steps on aspects of the pay bill which include a non nett growth at the corporate centre and a pause of senior management / administration (Grade 7) is ahead of target across the organisation. An analysis of year end forecasted financial position will be reported to the June Board meeting based on Q1 data.

Regarding the current HR position, the Board were informed that employment levels at the end of March 2023 showed that there were 139,838 WTE (equating to 158,582 personnel) directly employed in the provision of Health & Social Care Services by the HSE and that the various Section 38 hospitals & agencies and the March 2023 outcome is strongly ahead of target at +306 Whole Time Equivalents (WTE’s).

Regional Health Authorities (RHA’s)

The Board were informed that documentation regarding RHA’s is likely to progress from the Department of Health through Government process in June.

2.2 Board Strategic Scorecard 2023

The CEO presented the May Board Strategic Scorecard (BSS) 2023 for the March reporting period, as circulated prior to the meeting.

As agreed at the April Board meeting, due to data not being available to report a complete KPI suite to the Board in line with the monthly Board Strategic Scorecard submission timelines, KPI data is to be reported two months in arrears in the monthly Board Strategic Scorecard report, which will ensure a more complete view of progress and performance in the monthly reports.

The Board reviewed and approved the BSS for May 2023, reflecting March data, for submission to the Minister for Health.

PWC officials Gary Holohan and Yvonne Mowlds joined the meeting.

The Chairperson welcomed Gary Holohan and Yvonne Mowlds from PWC to the Board meeting. The Chair referenced the work to date that was carried out by the Technology and Transformation Committee on Transformation priorities. He noted that the objective of the workshop is to review and discuss a proposed Prioritisation Framework, to review the scale and complexity of the current range of programmes under the remit of transformation, to discuss key considerations to support the Board in identifying its priorities within the transformation programmes.

The Board reviewed the methodology used at the Technology and Transformation Workshop to develop the Prioritisation Framework noting that the programme was evaluated across two dimensions, Benefit (the extent to which the programme contributes to the objectives, targets and priorities of the HSE), and Ease of Implementation (the factors which will determine how easy or difficult it will be to implement the programme and realise the benefits). It was explained that the criteria used to determine Benefit and Ease of Implementation were weighted to reflect relative HSE priorities. The Board were presented with a description and weighting for each of the Benefit and the Ease of Implementation criteria used.

PWC identified a high-level overview of current projects, programmes and initiatives, following their review of a range of current corporate sources, and grouped them into either Transformational or Operational projects, programmes and initiatives.

The Board reviewed the range of all programmes against the Framework to prioritise transformational programmes. It noted that there were 133 high-level projects, programmes and initiatives classified as Transformational, which are typically large-scale, and are intended to bring about significant changes, or implement new processes, systems, or structures, and 117 high-level projects, programmes and initiatives classified as Operational, which are typically designed to improve the efficiency and effectiveness of existing processes and systems and are often smaller in scale.

It was agreed that the Prioritisation Framework will now be finalised for use as a management tool by the CEO with Senior Managers in July. It will also be used to support how the Board identifies its priorities for its workplan and Board Committee workplans and agendas and will help support the shape and focus on the new HSE Corporate Plan.

Gary Holohan and Yvonne Mowlds left the meeting.

4.1 Board Discussion with CEO

The Board noted Ministerial correspondence previously circulated, and the correspondence received on 30 May 2023 from Minister for CEDIY and the Minister for Disabilities relating to Specialist Community Based Disability Services.

The Board held a private session with the CEO.

4.2 Board Discussion with Mr Roderic O’Gorman, Minister for Children, Equality, Disability, Integration and Youth and Ms Anne Rabbitte, Minister for Disabilities

Minister O’Gorman, Minister Rabbitte and Department of Children, Equality, Disability, Integration and Youth officials joined the meeting. The Chairman welcomed Minister for Children, Equality, Disability, Integration and Youth, Mr Roderic O’Gorman and Minister for Disabilities, Ms Anne Rabbitte, to the Board meeting to discuss matters relating to specialist disability services following the transfer of functions to the Department of Children, Equality, Disability, Integration and Youth on the 1st March 2023. Minister O Gorman noted that the intention behind the transfer of functions is to deliver real and meaningful change for people with disabilities, by bringing together disability equality policy and oversight of specialist disability services within the remit of a single Department. Minister O’Gorman advised the Board of the ongoing engagements with the Department of Public Expenditure and Reform on the content of the Action Plan for Disability Services 2023 - 2026.

The Ministers discussed with the Board the progress to date and the challenges and opportunities ahead in Disability services. The discussion focused on the Department’s key priorities in respect of Disability services over the coming months including finalisation, approval and publication of the Action Plan for Disability Services coupled with the development of a successor national strategy to the National Disability Inclusion Strategy, to deliver transformative change in disability services. The Ministers emphasised that delivering this transformative change will require an ambitious commitment to prioritise Disability at every level and a mainstream first approach. They highlighted that, specifically for children's services, finalisation and delivery of the PDS Roadmap will be an essential indication that this kind of change is possible. In addition, investment in capital projects will also support sustained growth in capacity across the spectrum of Disability services.

It was noted that the Department of Children, Equality, Disability, Integration and Youth (DCEDIY) is also working closely with the HSE regarding the continued development of financial and governance arrangements post transfer of functions including accessing accurate and consistent information and data related to disability service areas.

It was agreed that, in respect of workforce, the number of unfilled vacancies in Disability services and in particular in CDNTs (34% vacancy rate) requires ongoing focus. HSE/DCEDIY will continue to work together in order to explore ways in which interdepartmental and interagency co-operation can help support developing a pipeline to increase the supply of therapists into the workforce. This will include increasing supply of personnel to disability services in the medium to long term through higher education institutes and also focusing on more immediate measures, such as options for short term conversion courses for assistants to therapists, or SNAs to therapists etc. The other significant workforce issue discussed concerned pay for Section 39 staff.

The Board confirmed its strong focus and outlined the support of the Board and the HSE to ensure a more equitable approach to the delivery of key services. In this context, the Board noted there is a collective effort being made nationally and regionally to fundamentally reform how we deliver services for people with a disability. A key focus is to support people with disabilities to ‘live ordinary lives in ordinary places’ and to reconfigure disability services and supports to achieve this critical aim. The implementation of the Progressing Disability Services for Children & Young People (PDS) programme will support the reconfiguration of children’s disability services to provide equitable, child and family centred services based on need rather than diagnosis.

The Board acknowledged that when the transfer of Specialist Community Based Disability Services from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth is viewed through statutory responsibilities such as Assessment of Need (AON) and service deliver models such as respite care, personal support, alternative care (de congregation), the organisation is challenged to meet this objective. The backdrop of unmet need is manifesting itself in the complexity of presentation in more cases and the resulting confidence of the public as evidenced in the Courts, political discourse and the media is quite low.

It was recognised that the HSE and the sector it depends on to deliver services to people with a disability has many skilled and dedicated personnel who make commendable efforts to respond to need. It was agreed that there should be continued strengthening of bilateral relationships at all levels to successfully underpin a structured and positive working relationship between DCEDIY and the HSE into the future to the benefit of disability services. The ongoing engagement was welcomed in that regard.

It was noted the Ministers informed the Board that DCEDIY is focused on strengthening bilateral relationships at all levels with and oversight of the HSE through the development of an Oversight Agreement, which will be finalised by Autumn, with an interim agreement in place that integrates financial and performance oversight. A key part of the Departments' role is to have clarity on the allocation and expenditure of public monies across the respective service delivery areas.

The Chairman thanked both Ministers for joining the Board meeting which provided a good opportunity to engage on and consider progress to date and the challenges and opportunities that lie ahead in Disability services, and it was also agreed that an annual meeting with the Ministers and Board should take place.

Ms Anne Marie Hoey, National Director Human Resources joined the meeting.

5.1 HSE Individual Senior Executive Accountability Framework Review

The Board considered and discussed the key aspects of the HSE Individual Senior Executive Accountability Framework Review undertaken by KPMG, as previously circulated.

The ND HR advised the Board of the HSE’s commitment to improving individual accountability and its aim to reduce harm to individuals and strengthen system performance by making individuals more accountable for their conduct and competence.

The Board noted the progress to date and that good practices have been observed, with several improvement initiatives carried out since 2019 which led to the enhancement of existing individual accountability structures. The Board noted that further improvements are needed, which will need to be considered with the establishment of the Regional Health Areas (RHAs).

It was agreed that Board members would review the Framework and provide further feedback to the ND HR which would be incorporated into the final report. The ND HR will progress and return to the Board in the Autumn.

ND HR left the meeting.

No further matters arose.

The meeting concluded at 4:00pm.