The Board considered the draft amended NSP 2023 and the eHealth & ICT Capital Plan 2023, which had been circulated in advance of the meeting. This draft had been prepared in line with the requirements set out in the Minister for Health’s letter of 20 December 2022 and subsequent additional requirements as set out by the Assistant Secretary, Department of Health (DoH) in his letter to the Chief Strategy Officer (CSO) of 22 December 2022.
The Board were informed that the proposed changes made in the amended NSP 2023 were informed by engagements with DoH Officials. It was also noted that the language in the Financial chapter of the amended NSP was negotiated between EMT and Officials in the DoH who have met since the Board had submitted the original draft plan to the Minister in November 2022. While the level of financial issue and risks remains the same in the NSP submitted in November 2022, the Financial chapter now quantifies issues and risks as a percentage of overall budget, (in total around 10.1%).
In its discussions, the Board noted that the amended NSP 2023 had been prepared in a particularly challenging financial and operational context, and that a significant amount of work had been completed in a short period of time to assess the level of financial issues and financial risk to be managed within the services in 2023. The NSP also sets out the assessment of the magnitude of financial issues and risks, of up to 3.3% of financial issues with an additional 6.8% of financial and operational risks including Covid and demand-led against our total Voted non-capital budget of €21,688.6m. The NSP also noted the DoH view that this overstates the level of financial issue for the cost of maintaining the existing level of service and that both the HSE and DoH are fully aligned on the need for any mitigation measures to ensure service capacity and therefore activity volumes and access times, for patients and services users, are not adversely impacted.
The Board members discussed the numerous challenges in the ongoing uncertain environment, and the affordability and achievability of the NSP 2023 in the context of a challenging operational financial outlook for 2023 which has been detailed in the NSP. They noted that without appropriate additional funding support, this will ultimately result in a significant financial pressure throughout the system in 2023. They outlined their concerns including the financial pressures that could be perceived as an unplanned budget overrun or interpreted as mismanagement by the HSE. The Board highlighted the importance of ensuring that all the challenges with the NSP are communicated effectively and clearly.
Concerns were also expressed about any potential impact on the delivery of services the delay in having a NSP approved with operating budgets established and adequate communications to managers.
To avoid potential misunderstanding or interpretation of the budget issues that may emerge in the year, it was agreed to highlight in the CEO’s foreword in the NSP that important information about significant financial issues and risks for NSP 2023 is contained in the Financial Management Framework.
The Board recommended that as part of the first 2023 financial review, which is due in May 2023, a reassessment should be undertaken of all financial issues and risks as set out in the NSP 2023.
The Board also discussed the challenges in relation to recruitment and retention of staff and it was noted that the recruitment requirement is currently in the region of 11,991 WTE with the labour market estimated to only supply 6,010 net additional WTE in 2023. These additional posts will be targeted at the vacancies that remain to be recruited under the NSP 2021 and NSP 2022, together with the posts associated with NSP 2023 service developments and the Haddington Road Agreement.
The Board agreed to adopt the Amended National Service Plan 2023 and eHealth & ICT Capital Plan 2023 for submission to the Minister for Health for approval, on the basis that the approach adopted within the Plan is communicated clearly to the Department of Health to ensure there is a clear understanding in relation to the challenging financial and workforce context in 2023.
(Decision no.: 030323/10)