HSE Performance and Delivery Committee meeting minutes 18 February 2022

Committee Members Present

Tim Hynes (PD Committee Chair), Brendan Whelan, Fergus Finlay, Sarah McLoughlin, Brendan Lenihan, Louis Flynn, Sarah Barry.

HSE Executive Attendance

Anne O’Connor (COO), Dean Sullivan (CSO), Stephen Mulvany (CFO), Dara Purcell (Secretariat), Jaymie Crone

Apologies

Brendan Whelan

Joined the meeting

Yvonne O’Neill (ND Community Operations), Orla Treacy (Operational Performance & Integration), Liam Woods (ND Acute Operations), Joe Ryan (ND Operational Performance & Integration), David Walsh (ND Integrated Operations), Richard Horne (PWC), Pat Moran (PWC), Yvonne Goff (ND Change & Innovation), Philip Crowley (ND Strategy & Research), Marie Carroll (Planning Specialist),

1.1 Welcome and Introductions

The Chair welcomed the Committee members to the meeting. The Committee held a private session where the Chair provided a brief summary on the agenda, the relevant papers and approach to conducting the meeting, noting that the focus of the meeting would be to receive updates on key items and to suggest relevant actions as they became apparent.

1.2 Declarations of Interest

No conflicts of interest were declared.

1.3 Approval of Minutes

The following minutes were approved by the Committee

• 21st Jan 2022

EMT members joined the meeting at 08.20am

Nursing Home Expert Panel Review (NHEP) Implementation

The ND Integrated Operations (IO) provided a update on the implementation of the recommendations of the NHEP Review, which sets out objectives that aim to implement significant change in relation to both how services are provided to patients directly in HSE care, as well as to support other providers to ensure that the required standard of care is delivered to individuals resident in nursing homes and requested feedback from the Committee.

The ND Integrated Operations informed the Committee that the NHEP Program is in close out phase with 62% of the recommendations completed for which the HSE has accountability and gave an overview on each of the 15 Expert Panel Themes noting the majority of recommendations are transitioning to business as usual implementation within Community Operations in Q1 2022.

In relation to funding, he stated that €13.3m has been approved in NSP 2022 for the HSE to continue implementation and adherence to the recommendations. Relevant Key Performance Indicators (KPI) across all quadrants of performance will also be monitored.

He highlighted the risk that achievement of WTE recruitment targets for funded initiatives in NSP 2022 may be impacted as a result of the scarcity of staff with required skill sets.

The Committee discussed the recommendation in relation to the GP lead roles on community support teams and nursing homes noting the approach has been similar in nature to the GP Lead currently being put in place for Community Health Networks (CHNs). The Committee expressed to ensure the development of this role does not negatively impact or over-burden current GP practices.

The Committee also considered the recommendation regarding Regulatory Recommendations and Broader ranges of Statutory Supports, in particular the need to expand access to home support and development of a statutory scheme for its financing and regulation. The importance of having adequate assessment systems and I.T. to support this and to aid in monitoring and decision making was highlighted.

The Committee noted there was no agreed timeline on updating the GRO office on the use of Computerised Infectious Disease Reporting (CIDR), which finds the linkages to outbreaks in infectious disease. The ND Integrated Operations confirmed that he will come back with an agreed timeframe on this.

The Committee discussed the pace of development of physical infrastructure and the ND Integrated Operations confirmed that the investment issues are being addressed in the 2022 Capital Plan.

The Committee requested that the next progress report would provide information on the implementation for each of the 68 individual recommendations (involving the HSE as the accountable body either as the lead agency or as a nursing home service provider) as opposed to at the thematic level. The next report should provide details, for each recommendation, of the person responsible for implementation, the current status broken down into a RAG rating and a timeline for when it will implemented and completed.

ND Integrated Operations left meeting at 08.50am.

The COO, ND Community Operations, Orla Treacy (Operational Performance & Integration), ND Operational Performance & Integration, ND Acute Operations joined meeting at 09.30am.

The Performance Profile and Operational Services Report for December 2021 and the Winter Plan Update were circulated to the Committee prior to the meeting for their review.

The Committee focused discussion on the Operational Service Report 2021 (OSR) which provided the results of the operational performance across all services based on expected levels of activity/targets as per National Service Plan 2021.

The National Director Community Operations provided an update on the performance of Community Services and also commented on GP retirements and impact on services particularly in rural areas.

The Committee considered the challenges in Community Services including the increase in waiting lists as a result of the impact of the almost two years of the COVID pandemic which has also been exacerbated by the cyber-attack in 2021.

The National Director Community Operations informed the Committee that additional resources have been secured for two waiting list initiatives which are currently underway targeted at patients waiting for orthodontic treatment for more than 4 years and children waiting for primary care psychology for more than 12 months. Additionally a submission had been made in January for an initiative to reduce numbers on the counselling wait list and plans are at an advanced stage to address Child and Adolescent Mental Health (CAMHS) waiting lists.

The Chief Operations Officer (COO) provided an update regarding challenges in radiology workforce, particular consultants, and related impact on services. The COO advised the Committee of work-inprogress to address challenges. The COO also referred to the reduction in dentists available for the Dental Treatment Service Scheme (DTSS) and the requirement for contract negotiations to be progressed on a priority basis.

The National Director Acute Operations provided an update on the performance in acute hospital services. Having previously highlighted at the April 2021 Performance and Delivery meeting that the Performance Profile of February 2021 reported six Serious Reportable Events as ‘death or encephalopathy of a normally formed neonate’ which have since been shown to be due to SARSCoV-2 Placentitis, the committee discussed the ongoing incidence and risks of SARS-CoV-2 Placentitis and the importance of vaccination in preventing it. The Committee were informed that there was a lot of emphasis on management of SREs in 2021 and the KPIs in NSP2022 have been revised. Quality and Patient Safety and Integrated Operations are working collectively to re-inforce reporting requirements of all serious incidents.

The Committee noted the (NPOG) December minutes and were informed that the ND Operational Performance and Integration and the COO are currently looking at how NPOG minutes could better reflect the issues discussed and the decisions and actions taken by NPOG to address any emerging performance issues.

Pat Moran (PWC), Richard Horne (PWC), ND Gov & Risk joined the meeting at 10:00am.

The Committee received an update paper on the Conti Post Incident Review (PIR) Implementation Plan which was circulated prior to the meeting for consideration.

The CSO noted that since the last Committee briefing on 21 Jan 2022, PwC have been engaged for a period of four weeks as an extension to the review process to prepare an initial, high-level plan of time-critical actions and to provide advice on programme structures and reporting processes.

He informed the Committee that Executive has completed draft job descriptions for the two key Senior leader roles in ICT / Cyber, namely the Chief Technology & Transformation Officer (CTTO) and the Chief Information Security Officer (CISO). Arrangements for the appointment of an Interim CISO are also progressing with a view to ensuring this position is filled by April 2022.

He expressed that in relation to the need for longer term specialist implementation support, the HSE is finalising drafts of the three long-term work-streams which consist of Programme Planning, Management, Monitoring and Reporting as well as IT and Cyber Transformation and Operational Resilience Transformation The final proposed work-streams and associated scope of works will be shared with P&D for consideration and comment in March.

PwC provided a PowerPoint presentation, which was a high level overview of the time-critical actions, programme structures and reporting processes of the Implementation Plan, to the Committee.

The Committee emphasised the need for the CISO job description to be strengthened to ensure the requirements of the role require the need for the successful candidate to be a driver of change as well as an expert in cyber and technology.

In relation to the CTTO role, the Committee re-iterated the need for the job description to ensure the successful candidate will have the required expertise to be a senior transformation agent. The Committee also suggested the candidate should possess senior leadership I.T experience in an organisation of a significant size and for the job description to specify the elements of leadership experience required. The Committee also suggested that the job description emphasises its desirable for transformation related to Health Systems, for example in eHealth.

ND Strategy and Research and Marie Carroll joined the meeting at 10:45am.

A briefing paper updating the Committee on the timelines for drafting of the 2021 Annual Report (AR) was circulated prior to the meeting for consideration. The ND Strategy & Research (SR) informed the Committee of the key dates and timelines relevant to the drafting of the AR 2021. It was noted that the first draft is to go to EMT 8 March 2022 before being considered by the Performance and Delivery Committee 11 March 2022. The penultimate draft is to go to EMT 12 April 2022 before being presented to P&D on 14 April 2022. The final draft is considered by P&D 21 April 2022 before being presented for Board Approval 27 April 2022 and subsequently being submitted to the Minister 18 May 2022.

The ND S&R noted that the AR will include focuses on the HSE’s operations during the second year of the COVID-19 pandemic, key achievements during the year, and how resources have been used more generally and will report at a high-level on progress against key priorities included in NSP 2021.

The Committee suggested to also highlight and include the importance of staff resilience during Covid, Environmental, Social and Governance (ESG) and Climate Action Change & Sustainability as well as the learning from Covid & the Cyber-Attack and that engagement with academic researchers on this might be beneficial.

The ND Change and Innovation joined the meeting at 11:30am.

The 2022 Waiting List Action Plan, which sets the plan to improve scheduled care to enable more timely access and reduce the number of people waiting for services in line with the NSP 2022 targets, was circulated to the Committee prior to the meeting for consideration.

The Committee were informed that the 2022 Waiting List Action Plan focuses on delivering immediate reductions in acute hospital scheduled care waiting lists through increased activity to impact volumes, while building on the work done in 2021 to lay the foundations for longer-term reforms.

To address waiting lists in 2022, the plan has been developed by focusing on four key areas: under which 42 actions will be completed through the 2022 which includes;

1. Delivering Capacity in 2022
2. Reforming Scheduled Care
3. Enabling Scheduled Care Reform
4. Addressing Community Care Access and Waiting Lists

Through this Plan, €350 million is being allocated in 2022 to the HSE and the NTPF to provide additional public and private activity to further stabilise and reduce scheduled care waiting lists and waiting times, in tandem with bringing forward much needed longer-term reforms.

The Committee discussed the HSE’s relationship with the NTPF in relation to managing of waiting lists and highlighted the importance of communication between both parties to ensure the efficient management of waiting lists and to deal with any issues that may arise in a timely manner.

The Committee discussed the use of the private sector to deal with capacity gaps and demand. It was noted that to align more with the key objectives envisaged in Sláintecaire, investing in capacity and demand analysis to pin-point areas that have deficiencies and weaknesses, will offer more public system sustainability.

The Committee welcomed the Action Plan as a key first step on the journey to tackling long waiting times and working towards the maximum waiting times identified in Sláintecaire. The Committee highlighted the importance of strengthening references in the Plan in relation to issues and risks to more fully reflect the scale of the challenge associated with the delivery in 2022.

The Committee noted the implementation of the 2022 Waiting List Action Plan will be governed by the Waiting List Task Force, co-chaired by the Secretary General of the Department of Health and the CEO of the HSE, and with senior members of the Department, the HSE and the NTPF. The Committee highlighted the absence of references in the Plan to the formal role to be played by the Board in overseeing the delivery.

The Committee’s views will be reported to the upcoming special Board meeting to consider the plan.

The Committee held a private session to debrief post meeting.

The meeting concluded at 12:10pm