HSE board strategy meeting minutes 28 July 2023

A meeting of the Board of the Health Service Executive was held on Friday 28 July 2023 at 9:00am in Dr Steevens’ Hospital.

Present:

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

Remotely: Prof Deirdre Madden and Tim Hynes

In Attendance for Board Meeting:

Mr Bernard Gloster (CEO), Brian Murphy, (Head of Corporate Affairs), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Deputy Corporate Secretary), Ms Patricia Perry (Office of the Board)

Joined the meeting:

Mr Stephen Mulvany (CFO), Mr Dean Sullivan (CSO), Mr Damien McCallion (COO), Ms Anne Marie Hoey (ND HR), Mr Joseph Duggan (ND IA), Dr Philip Crowley (CCO), Mr Fran Thompson (CIO), Mr Paul de Freine (ND Capital & Estates), Mr Mark Brennock (ND Communications), Mr David Walsh (Incoming ND Community Operations) and Mr Bernard O’Regan (Head of Operations Disability Services)

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 Chairperson welcomed members to the meeting.

The Chairperson provided an update to the Board during their private session on a number of matters.

The Chairperson welcomed members to the meeting and provided an update to the Board during their private session on a number of matters. The Chair informed the Board that he and the ARC Chair are meeting with several individuals regarding ARC Committee membership and following completion of this process a communication will be issued to the Board seeking approval of new members.

The Board received an update regarding the recruitment process for the Chief Technology and Transformation Officer (CTTO) and Chief Information Security Officer (CISO) positions.

The Board discussed the September Board meeting, and it was agreed that the meeting will be held over a two-day period with day one being a Board Strategy Day.

It was agreed that a recent Patient Experience which had been shared with the Planning and Performance Committee would be circulated to the Board for information.

1.3 Minutes of Board meeting

The Board approved the minutes of the Board meeting of 30 June meeting subject to an amendment under the Audit & Risk Committee update.

2.1 CEO Report

The Chair welcomed the CEO to the meeting. 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. Discussions were held on the following aspects of the report.

Mental Health Commission

The Board welcomed the Mental Health Commission’s Final Report of the Independent Review of the provision of Child and Adolescent Mental Health Services (CAMHS) in the State by the Inspector of Mental Health Services.

The Board discussed and acknowledged the concerns the report raises in areas such as service delivery, staffing and governance as well as specific concerns regarding children and young people in the care of CAMHS and agreed that it was the responsibility of all in the HSE to work together and improve services to be more responsive in both access and quality of outcome.

The CEO informed the Board that he has engaged with Dr Finnerty in the closing stages of her work and the HSE’s commitment to continuous improvement in CAMHS. He also briefed the Board on the following initiatives that are being undertaken.

• The progressing of a new HSE Child and Youth Mental Health Service improvement programme.
• The establishment of a new National Office for Child and Youth Mental Health which will lead out on this programme to provide leadership, oversight, and enhanced governance to services.
• The appointment of both a National Lead and a National Clinical Lead (CAMHS Psychiatrist) for Child and Youth Mental Health to lead this office and the service improvement programme.

The Board agreed that the Safety and Quality Committee Chair and the Performance and Planning Committee Chair would meet with the Chief Clinical Officer (CCO) and the Chief Operations Officer (COO) to discuss and agree arrangements for the oversight of the implementation of the recommendations in the report and the overall development of the HSE Child and Youth Mental Health Service improvement programme.

National Independent Review Panel (NIRP) - Emily Report & Safeguarding

The Board welcomed the publication of the Emily report and the Safeguarding Report Findings and supported the apology that was issued by the CEO on behalf of the HSE to the family of Emily.

The CEO confirmed that the appointed external safeguarding expert, Ms Jackie McIlroy has commenced work to ensure that there is a full understanding of all of the issues relating to this case. She is conducting her own enquiries and will report to the CEO in the next number of weeks. The CEO confirmed that the experts report will be published.

The CEO also confirmed that the report on safeguarding will be brought to the Board to help in finalising the approach to safeguarding for the future as both structure and culture are significant challenges despite the excellent work of those involved.

Breastcheck Radiology Shortages

The CEO informed the Board that the programme remains 12 months behind schedule due to the pause in services during the covid pandemic and is under active monitoring by the Breast Screening Executive.

Our Lady’s Hospital Navan (OLHN)

The CEO noted that HSE OLHN operational group is meeting to progress the key issues that are required in advance of full reconfiguration.

HSE Health Regions

The CEO provided an update with regards to the implementation of the HSE Health Regions implementation plan noting it was approved by Cabinet and was due to be published in the coming days.

He briefed the Board on the Implementation Plan including key actions and timelines for 2023 and 2024 to deliver more integrated care closer to patients’ homes by bringing hospital and community services together; to plan and deliver services around the needs of local populations; to improve governance and accountability at all levels; and to strengthen local decision-making and provide consistent quality of care across the country.

He advised that the Government approved the recruitment of the 6 Regional Executive Officer posts to lead the Health Regions. These posts will be very important in establishing our Health Regions from February 2024. The recruitment process for these posts will now commence with an aim to having the positions filled and in place by Q1 2024.

The Board discussed the importance of alinement between Health Regions and academic / medical schools and GP training schemes; the need for patient service user engagement in the design and roll out of the regions; and the focus on performance and culture at regional level.

The CEO also presented a high-level draft overview proposal regarding the redesign of the HSE at National Level which will have two components, a HSE Corporate Centre and HSE National Services.

The CEO noted that this was a first introduction approach, and each step would need to be worked through as an iterative process involving the Board and Department of Health prior to a final draft position. This would then be moved to a consultation process followed by an implementation plan and process.

The CEO invited the Board members to give feedback on the document directly to the Board Office by end of August which will be considered in the context of the next draft of the document.

The Board welcomed the direction of travel of the document.

2.2. Board Strategic Scorecard Review

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

The Board noted the overall average rating of 2.84, down 0.01 since June 2023. 15 scorecards maintained their June ratings, two downgraded their ratings, eHealth from a 5 to a 4, and Planning and Implementation of Health Regions from a 3 to a 2. Two Scorecards increased their ratings, Unscheduled care – Emergency Department Performance from a 1 to a 2, and Communications from a 3 to a 4.

The Board discussed and approved the BSS for July 2023, reflecting May data, for submission to the Minister for Health, and a copy to be sent to the Department of Children, Equality, Disability, Integration and Youth.

The CSO then took the Board through each individual Scorecard to which the Board reviewed.

The Board suggested in relation to Deliverables on all Scorecards, where the status is inputted as delayed, to include expected date rather than delayed.

In relation to BSS 9 Enhancing Bed Capacity - ICU beds, the Board discussed the recruitment and retention of ICU Nurses, and the support for staff training with and the option of blended learning, to which the ND HR agreed to check and revert back to the Board.

The Board questioned the mandatory training relating to BSS 11 Patient and Service User Partnership - Assisted Decision Making (ADM) and the HSE Consent Policy training, and the CEO agreed to review the requirement for mandatory training.

The Board asked that further consideration of the KPI with regard to the minimum statutory employment target for persons with disabilities, to be employed in the public sector which is currently 3%, to be given in relation to BSS 7 Reform of Disability Services, to which the CEO agreed to consider.

The Board stated that the rating of 4 in BSS 6 Reform of Mental Health does not relate to the current state of mental health services, and the CEO agreed to review the Ambition Statement and KPI for mental health for 2024.

In relation to BSS 10 Quality and Patient Safety, Board members outlined their frustrations with regard to the signals programme MDT recruitment which is on hold due to the recruitment pause. The CEO, COO and CCO agreed to look at applying discretionary exemption of the recruitment pause relating to this programme.

The Board discussed BSS 19 Women's Health and asked that consideration to include a KPI in 2024 in relation to Maternity Incidents.

In relation BSS 12 Recruitment and Retention, the Board requested that more focus is required in relation to Retention as well as Recruitment for 2024.

3.1 Contracts & Properties

The CEO presented to the Board the following papers which were recommended by the Audit & Risk Committee for approval, to which the Board considered and approved.

4.1 Audit and Risk Committee

The minutes of the Committee meeting of 6 June 2023 were noted and the Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 14 July 2023.

The Chair advised the Board that the Committee were provided with an update from the CRO in relation to the Corporate Risk Review, and a further update will be brought to the meeting in September. The Committee noted the status of the implementation of the 50 recommendations contained in the Moody Risk Review, and focussed in particular on the 12 Critical Path recommendations identified. The Committee emphasised their support in ensuring that the Report’s recommendations are implemented across the HSE, and welcomed that progress continues to be made in implementing the recommendations and this work continues to be central to the activities of the Enterprise Risk Management Team.

The Committee were provided with an update in relation to the YTD Financial Position as at May 2023, and Health Budget Oversight Group (HBOG).

The Committee were presented with a paper on the HSE Personal Protective Equipment (PPE) Phase 2 Report & Assurance by officials from KPMG, which gave assurance that 15 recommendations had been implemented, and 2 recommendations which were due to be implemented by November 2022, had not been implemented. The Committee noted that they relate to the creation of a new National Emergency Framework which is currently under way.

The Committee considered the detail relating to Contract Approval Requests (CARs). The Chair advised the Board that in relation to the Authorisation Scheme for the Provision of Home Support Services for Older People, the Committee outlined their concerns with regard to the reduction of home help hours from 23.9mn to 22.0mn hours, and as it was not clear why the service was reducing, approval was withheld by the Committee.

The Committee also considered the detail of the remaining proposed CARs, National Contract for the provision of RT-PCR Testing of Covid (and pandemic) Specimen Samples, and Mini-Competition for Contact Management and Related Administrative Services for HSE Live and PCRS and agreed to recommend them to the Board for approval.

The Chair reported that an update was provided by the ND IA with regard to a review which was undertaken by IA to assess whether actions to resolve audit findings were implemented as reported by management and review Internal Audit’s tracking processes. The Committee highlighted their concern in relation to the number of outstanding recommendations which were very unsatisfactory and queried what was the level of oversight in the individual areas for the implementation of the recommendations. The Committee reiterated that if there is no improvement, managers will be required to attend an Audit & Risk Committee meeting to provide an explanation.

The Chair advised the Board that the Committee reviewed a paper seeking approval for the re-allocation of funding in the Capital Plan 2023. He advised the Board that the Committee had also discussed the possibility of directing some or all of the potential capital underspend towards the HSE’s revenue budget.

A summary report on transactions approved between €2m & €10m and low value/nominal CAT 3a transactions for the period of 1 April – 30 June 2023 was noted by the Committee.

The Committee considered the detail of proposed contracts, relating to Disposal of GP residence and former clinic, Inis Mór, Aran Islands, Co Galway and the Proposed lease of Surgical Hub in North Dublin, and agreed to recommend to the Board for approval.

The Committee also considered a contract that was unable to go to the Technology & Transformation Committee, Renewal of Dedalus Support and Maintenance contract, and agreed to recommend the contract to the Board for approval.

4.2 People and Culture Committee

The minutes of the Committee meeting of 12 May 2023 and the HR Dashboard were noted and the Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 13 July 2023.

The Chair advised the Board that the Committee were presented with the Internal Communications report which included an update in relation to the development of a new staff email system, to which the Committee requested that this issue be brought to the attention of the Chair Technology and Transformation Committee.

The Committee were briefed on communications in relation to the Staff Survey, Climate Action Survey, Health Service Excellence Awards, Grad Link and Pride Celebrations, and congratulated the Internal Communications Team on receiving a special award at the PRII (Public Relations Institute of Ireland) awards ceremony in June.

The Chair advised the Board that the Committee were provided with an update on the Public Only Consultant Contract (POCC23), and the implementation of the recommendations of the interim report of the NCHD Taskforce.

The Committee were updated on the number of staff employed in the disability service, noting that the data provided demonstrated a net growth of 1843 WTE / + 10% across various categories of staff. The Chair advised the Board that that this information will be made available, with commentary, to the Department of Children, Equality, Disability, Integration and Youth. The Committee discussed the HSE percentage of staff employed who have a disability in the context of the statutory employment target of 3% for employment of persons with disabilities, and the ND HR will draft a briefing note for circulation to Committee members.

The CEO agreed to speak to the National Disability Authority with regard to the reporting criteria of the statutory employment target of 3% - 6% for employment of persons with disabilities.

The Committee received an update on the HR priorities for the 2024 Service Plan, a briefing in relation to CRR9 - Health, Wellbeing resilience and safety of staff, and were presented with the services provided by the HSE HR Workplace Health & Wellbeing Unit which include Occupational Health, National Employee Assistance Programme, National Health & Safety Function, Rehabilitation, and Organisational Health.

4.3 Planning and Performance Committee

The minutes of the Committee meeting of 23 June 2023 were noted and the Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 21 July 2023.

The Chair advised that the Committee received an update on Communication items by the ND Communications particularly in relation to the NSP 2023 and disability services.

The Committee was presented with the monthly COO Report, Operational Service Report (May Data), Performance Profile (May Data), National Performance Oversight Group (NPOG) Meeting Notes (May Data), and the PMO Report – Winter/NSP 2022-23, with a focus on Scheduled Care, Urgent and Emergency Care (UEC) and Child and Adolescent Mental Health Services (CAMHS).

In relation to Scheduled Care, the Chair advised the Board that the Committee sought detail on waiting list management, particularly actions being taken to provide care for patients who have been on waiting lists for extended periods of time, and were provided with an update by the ND Acute Operations in relation to the dynamic purchasing solutions (DPS) that are being utilised as a short term solution.

In relation to UEC, the Committee were advised that the system has stabilised over the past number of months although it remains challenged by KPIs. The Committee discussed whether zero tolerance in relation to certain KPIs should be the aim and the culture shifts that may be necessary in some sites to achieve this.

The Committee noted that the Mental Health Commission (MHC) report on CAMHS was due to be published, and welcomed the confirmation that clinical leads for CAMHS and the adult mental health services had been appointed.

The Committee received updates relating to an older persons home care staffing tender process; Urgent Colonoscopy and Cancer Services; Therapy Waiting Lists; Serious Incident KPIs; Disability Services Assessment of Need, and escalation to National Directors under the Performance Accountability Framework 2023.

The Committee were presented with the draft Roadmap for Service Improvement 2023-2025 Disability Service for Children and young People (the Roadmap) and the Roadmap’s Monthly Progress Report. The Chair advised the Board that the Committee queried some of the language and tone of the Roadmap and recommended that it be amended to become more communicable for families.

The Committee discussed Corporate Risk Register 04 – Access to Care, and queried the allocation of risk controls and the clarity of the connection between the control and the risk description, and were updated in relation to the Health System Performance Assessment (HSPA) Framework for the Irish health system, and the National Service Plan 2024.

4.4 Safety and Quality Committee

The minutes of the Committee meeting of 16 June 2023 and the Quality Profile (May data) were noted. The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 14 July 2023.

The Chair advised the Board that the Committee were provided with an update in relation to the National Independent Review Panel (NIRP) Annual Report 2022-2023 and that NIRP have now completed four major reviews into serious reportable events and an independent review recommended, and are in the process of completing a further two reviews and will report back to the Committee.

The Chair briefed the Board on the monthly Chief Clinical Officer’s report which included an update with regard to MonkeyPox, the National Cervical Screening Laboratory (NCSL) project to build and equip the new laboratory, the Cervical Check and the Laboratory services tender, BreastCheck Radiology Shortages, The World Health Organisation’s International Agency for Research on Cancer (IARC), Radiology Diagnostics Review Imaging capacity, National Womens and Infants Health Programme (NWIHP) OEST programme, Our Ladys Hospital Navan (OLHN), Quality Profile Metric, “Urgent and Emergency Care – people over 75 years and older”, Sodium Valproate, Anti-Microbial Resistance and Infection Control (AMRIC) – Carbapenemase-producing Enterobacterales (CPE), and Genetics and Genomics.

The Committee received an update in relation to Corporate Risk Register 018 - Assisted Decision-Making Capacity Legislative Changes and the commencement of the Assisted Decision-Making (Capacity)(Amendment) Act 2022 in April 2023 and its evolving impact on both service users and their families and HSE services.

The Chair advised the Board that the Committee heard directly from patient representatives from Patients for Patient Safety Ireland (PFPSI) and were updated on the ‘Know, Check, Ask’ information campaign as well as iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years).

The Committee were updated on the Mental Health Commission’s (MHC) Annual Report 2022 and advised the Board that Mental Health has developed a detailed action plan in response to the MHC findings which is due to be submitted on 31 July 2023.

A discussion then took place in relation to Our Lady’s Hospital Navan (OLHN), and the CEO advised that there has been no further update since the June Board meeting.

4.5 Technology & Transformation Committee

The Chair of the Technology & Transformation Committee advised the Board that there was no meeting held in July 2023. The next meeting will be held in September which will include a Committee meeting and workshop to consider the PwC analysis of the status of recommendations contained in the PIR Report, to which Board members are welcome to attend.

The Committee were updated in relation to the recruitment process for the positions of the Chief Technology & Transformation Officer (CTTO) and the Chief Information Security Officer (CISO).

5.1 Services for People with a Disability

The Board were presented with Disability Services and Roadmap for Service Improvement for Children’s Disability Network Teams (CDNTs) Services. The Head of Operations Disability Services stated that the HSE Service Plan 2023 provides for a range of services to persons with disabilities and their families, with an assigned budget of approximately €2.6 billion.

The Board noted that:

• 2,102 WTEs planned to work on 91 CDNTs which will co-ordinate and provide support to children and young people with complex disability support needs, which includes the current 707 funded vacancies in the service, and incorporates the commitment to deliver supports in Special schools for which 136 additional posts were provided for.
• 447 intensive respite support packages will be provided for children and young people with complex/high support needs focusing on families experiencing substantial levels of support need.
• 8348 residential places will be provided to people with a disability (where 90% relates to those with intellectual disabilities and Autism.
• Over 21,390 people with disabilities will access rehabilitative training or day places and supports in over 800 locations throughout the country.
• 5,758 people with disabilities will avail of 129,012 overnight respite and 24,444 day only respite sessions.
• 10,016 people with disabilities will avail of 4.89m hours of personal assistant/home support hour.

The Board discussed the concerns relating to the demand for increased capacity across all services, the waiting lists for services, the retention and recruitment of staff and ensuring services are integrated across services and agencies.

The Board highlighted the recent press statement by the Minister for Children, Equality, Disability, Integration and Youth, Roderic O’Gorman, and Minister of State for Disabilities, Anne Rabbitte, welcoming the Government approval of the Disability Action Plan 2024-2026, which the Board have not had sight of. The Board noted that the Action Plan sets out the first phase of work to build the necessary capacity required in Disability Services, setting out a vision of disability supports and services that:

• Enable people with disabilities live a full life of their choice in the community,
• Provide the right supports, at the right time, when they are needed,
• Fulfil the promise of the UN Convention on the Rights of Persons with Disabilities. The Head of Operations Disability Services advised the Board that the Action Plan will be published in September, but that he will liaise with DCEDIY to ensure that the Board receive a copy.

5.2 Roadmap for Service Improvement 2023-2025 Disability Services for Children and Young People

The CEO presented to the Board the Roadmap for Service Improvement 2023-2025 Disability Services for Children and Young People which is a targeted Service Improvement Programme to achieve a quality, accessible, equitable and timely service for all children with complex needs as a result of a disability and their families. It sets out the overall aim for Children’s Disability Services, provided by the HSE and its partner agencies, and is for every child to have a childhood of inclusive experiences where they can have fun, learn, develop interested and skills, and form positive relationships with others in a range of different settings.

The Board discussed the significant challenges for CDNTs to achieve the level, quality and types of service, such as waiting lists, recruitment and retention of staff, demand for Assessment of Need (AON), and the growing service demand.

The Board noted that the HSE Disability Services have developed a range of governance structures for Children’s Disability Network Services at national and regional levels. These structures include Service providers, managers and staff, and family representatives. The Board welcomed the Family Forum which is being established to run in parallel with each of the 91 CDNTs. The purpose of the Family Forum is to engage families in service development and improvement of their CDNT. This is to ensure that the family voice and experience is embedded at all levels of governance and development of Children’s Disability Services.

The Board welcomed that a suite of metrics to monitor the implementation of the Roadmap for Children’s Services will be reported monthly and that oversight structures will be established at inter-departmental and HSE National to oversee the implementation of the Roadmap for Children’s Services.

The CEO advised the Board that there has been ongoing engagement with the Minister for Disabilities and officials of the Department of Children, Equality, Disability, Integration and Youth (DCEDIY) in the development of the Roadmap and that the Minister has agreed to approve the Roadmap. He advised that the Planning and Performance Committee had contributed to the development of the Roadmap for Service improvement. The Chair of the Planning and Performance Committee advised the Board that the Committee recommended the Roadmap for Board approval.

The Board welcomed and approved the Roadmap for Service Improvement 2023-2025 Disability Services for Children and Young People and emphasised that the successful implementation of the Roadmap is essential to improving access to services; improving confidence in the service model and securing future resources to enhance the services further, and to improve compliance with the legal requirements for Assessment of Need under the Disability Act 2005.

It was noted that there would be no Board meeting held in August and the September Board meeting would take place in person in Dr Steevens’ on 28 and 29 September 2023.

The meeting concluded at 3.30pm.