A meeting of the HSE Performance and Delivery Committee was held on Friday 23rd April 2021 at 8am via video conference.
From: HSE Board
Published: April 2021
Updated: December 2024
Tim Hynes (Chair), Fergus Finlay, Sarah McLoughlin, Brendan Lenihan, Regina Moran, Louis Flynn, Sarah Barry.
Anne O’Connor (COO, Item 2-4), Liam Woods (ND Acute Operations)(Items 2-4), Yvonne O’Neill (ND Community Operations, Items 2-4), Orla Treacy (Items 2-4), David Walsh (Implementation lead) (item 4), Dean Sullivan (CSO, Item 2), Stephen Mulvany (CFO, Item 4), Dara Purcell (Secretary), Hannah Barnes.
The Chair welcomed Committee members to the meeting and held a private session to consider the agenda and papers for the meeting and the approach to conducting the meeting.
No conflicts of interest were declared.
The Committee approved the minutes of the meeting of 19 March 2021. EMT members joined the meeting at 8:30am.
The COO, ND Acute Operations, ND Community Operations, CFO, and Orla Treacy joined the meeting at 8:30.
The Committee considered the February 2021 performance profile and operational services report and noted the assurances provided with the view to further discussing the information provided under item 3. National Service Plan 2021 Review.
The Committee noted the HSE Operational Services Report Dashboard Project Progress Update Report which was circulated to the committee in advance of the meeting and approved the continued development of the project.
The Committee reviewed with the COO papers on the Review of Public Private Status of Residential Care facilities linked to Covid-19 Deaths, which had been circulated in advance of the meeting. In response to questions regarding the data the COO clarified that the data is captured by HPSC and is not currently provided in the format of deaths by bed numbers rather than facility. The COO confirmed that a national picture of public nursing home beds with private beds which are publicly funded could be provided to the Committee. The Committee requested that further consideration is given to seeking the data related to public and private nursing home per bed.
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COO, ND Acute Operations, ND Community Operations, and O Treacy joined the meeting
The COO reviewed with the Committee the paper on the National Service plan (NSP) 2021 Q1 Review - Phase 1 which was circulated in advance of the Committee meeting. The COO outlined that the review was necessary due to the NSP 2021 being drafted based on the government’s planning assumptions for Budget 2021 which included Level 3 restrictions, or lower, and did not include a vaccination programme. The Chairman’s submission note accompanying the final NSP2021 committed to writing to the Minister in April following a review of progress in Q1, given the pressures, complexity and uncertainty caused by the 3rd COVID surge and the Vaccination Programme. The COO informed the Committee that the NSP2021 Q1 Review focuses on key transformation and other programmes which are included in the monthly Board Strategic Scorecard and a subset of operational KPI’s within NSP2021 that are aligned with the National Performance Oversight Group (NPOG) Focus Areas.
The Committee noted that the Q1 review is being completed in two phases with phase 1 tasked at looking back and comparing what was expected / planned when the NSP2021, and its targets, were originally adopted; what has been achieved to the end of February/March and what were the major drivers of any divergence from plan. The COO provided the Committee with a synopsis of the next steps (Phase 2) that will be taken under the review.
The COO and Committee discussed activity and performance results from a number of areas including Mental Health Services, Cancer Services, and Older Person’s Services which have all faced challenges due to the interruption to planned levels of service.
Regarding the variances in Mental Health Services results and the statistics for CAMHs waiting lists, the COO said that the review is considering what was planned to be achieved in Q1 2021 rather than an assessment of unmet need.
The COO noted that colonoscopy services had been most severely impacted during the pandemic and as a result a key issue remains with the Colonoscopy/OGD waiting list which has increased. There has also been an increase in the number of urgent colonoscopy breaches. Regarding Cancer Services it was also noted that the fall in e-Referrals noted in Wave 1 of the Covid-19 pandemic, did not reoccur during Wave 2 and 3 and that all of these clinics continued, albeit with a combination of face to face consultation and virtual consultations as deemed clinically appropriate.
The NCCP is undertaking a review of performance of rapid access clinics by site in conjunction with the relevant clinical leads and Acute Operations to determine key causal factors for any reported under compliance and an improvement plan will be agreed for each site. In response to questions from the Committee the COO noted that the Access to Care Plan is still to be signed off and once this plan comes into effect it should be reflected within the findings of phase 2 of the review.
The CFO highlighted to the Committee that there are instances at the end of Q1 where the deliverables in specific strategic programmes and costs incurred do not align i.e. underspend on planned costs and confirmed the intention and requirement to retain funds for intended initiatives such that they are available to progress initiatives at relevant time i.e. funding not re-allocated for other purposes.
When asked about the source of KPIs within the Performance Profile and Operational Services Report, the COO confirmed they are metrics within the National Service Plan. The Committee highlighted the importance of finding balance between communicating the progress and status of services meeting KPIs but also acknowledging that due to the ongoing pandemic some people will still be negatively affected. In the context of the NSP2021 Review the Committee requested that the COO consider how to add commentary on particular data categories such that there is context to the operational KPI’s within the review.
Questions regarding the increase in serious critical events within neo natal services were also raised. It was agreed that the ND Acute operations would revert back to the committee with further information as the Women and Infants Programme is currently looking at this. The Committee noted that the development of the Board scorecard and Operational Services Report has allowed for more targeted discussions to take place on the performance profile.
It was agreed that there would be key learnings to take from both phase 1 and phase 2 of the review.
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The Implementation lead joined the meeting at 10:18.
The Implementation Lead briefed the Committee on the HSE Nursing Homes Expert Panel Implementation of Recommendations Update April 2021 paper which had been circulated in advance of the meeting.
The Implementation lead outlined that the Nursing Homes Expert Panel was appointed by the Minister for Health in May 2020 and published the COVID-19 Nursing Homes Expert Panel Report on 19th August 2020. The Report contains a range of recommendations, across 15 themes, in line with the lessons learned to date and international best practice aimed at safeguarding the residents in nursing homes over the next 12-18 months and into the longer term. In total the HSE is the accountable body for 68 of the 86 recommendations from the report and to date work has completed on 10% of the HSE in scope recommendations.
Within the HSE, 5 workstreams have been developed to drive the implementation of these recommendations within the Organisation and the implementation of these recommendations is overseen by the HSE implementations of Recommendations Steering Group, of which the COO is the Chair.
It was noted that the majority of the recommendations fall within the operations division of the HSE and it was highlighted that there is strong coordination between the steering group recommendations and the HSE’s own plans. In particular the Implementation lead highlighted that critical recommendations relate to the development of competencies in the care of older persons and promotion of greater integrated working practices.
Work is ongoing with Human Resources to drive standards in this area. The Committee noted that over the last few last months the Minister for DFHIRS issued statements on expanding the number of apprenticeships available in the public sector and in particular in the health service. A meeting with the Secretary General of DFHIRS and senior officials of DoH took place in March to discuss the possibility of introducing an apprenticeship specifically for Health Care Assistants. The HSE has agreed that an apprenticeship will be introduced.
The Committee acknowledged the work being dedicated to implementing the recommendations and discussed with the Implementation Lead the HSE’s overall role in the review of the sector. The Implementation lead highlighted that it was important that any work carried out is led by clear policy and a strong regulatory framework.
The Committee requested that consideration is given to reporting on issues as to why some implementation plans have not yet progressed and asked for a report to come back with more detail. Also, following questions from the Committee the Implementation Lead outlined that not every Nursing home has a primary GP yet and that work is still progressing in this area. The Committee requested a more detailed updated from the information available that will demonstrate progress regarding implementation of all recommendations.
There was a related discussion regarding the Committee primarily focussing on more complex recommendations that require delivery and net issues for HSE. The Committee suggested that minutes of DoH Implementation Oversight Group meeting’s and HSE Governance Group meeting’s be shared and also that regular implementation updates be provided to the Committee.
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COO, ND Acute Operations, The Implementation lead, and O Treacy left the meeting.
Brendan Lenihan left the meeting at 11:00
The CSO provided a synopsis of the changes made to the presented version of the Annual report highlighting that the Committee feedback from its meeting of the 19th of March and 16th April have been taken on board and are reflected within the document.
The CSO highlighted that financial data which is to be submitted within the report will be updated to ensure alignment with the Annual Financial Statements once they have been approved and signed off.
The Committee thanked the CSO and the Annual Report team for their work on the report so far and provided some minor feedback for consideration. It was agreed that a final draft of the Report should be brought to the next meeting of the HSE Board.
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