HSE Performance and Delivery Committee meeting minutes 8 November 2022

Committee Members Present:

Fergus Finlay (Chair), Brendan Whelan, Anne Carrigy, Sarah McLoughlin, Sarah Barry.

Board Members Present:

Brendan Lenihan.

HSE Executive Attendance:

Dean Sullivan (CSO), Mairead Dolan, (Interim CFO), Stephanie O’Keeffe (ND Operations Planning), Philip Crowley (ND Strategy and Research), Miin Alikhan (AND Strategic Planning and Reporting), Dara Purcell (Secretary).

The Committee Chair welcomed members and EMT to the meeting noting that the purpose of this meeting was to update the Committee on the National Service Plan (NSP) 2023.

1.1 Declarations of Interest

No conflicts of interest were declared.

The CSO provided an overview of Draft 2 of the NSP which had been circulated for consideration and review by the Committee prior to the meeting. He thanked the Committee for reviewing the NSP Draft 1 at their meeting on 2 November and advised that Draft 2 is substantially complete other than a small number of outstanding queries, generally related to expected activity and performance levels in 2023. It was noted that the NSP 2023 is informed by the Minister for Health’s Annual Statement of Priorities within the LOD, and has been prepared within the wider strategic context of Sláintecare and the HSE Corporate Plan 2021 – 2024.

The CSO advised that extensive coordinated service planning has occurred across the HSE to ensure the affordability and deliverability of our NSP 2023 in light of significant challenges which, together, present a complex planning/operational/HR/finance context that requires a multi-year perspective.

In relation to financial challenges identified in the Draft NSP, the CFO advised that this year’s LOD provides a total revenue budget of €21.124bn, an increase of 5.7% on this year’s starting budget as set out in NSP 2022. This excludes once-off funding of €564m in 2023 for COVID-19 related costs. Within this year’s budget, an additional €240m has been provided for service developments (only for the non-pay elements). She outlined that the NSP identifies a number of areas of risk where it has not been possible to provide for financially in 2023 as these areas collectively are beyond the normal level of financial risk that is managed in any given year, and that each of these areas will require careful monitoring and management during 2023 by HSE and the Department of Health.

The CSO further advised that these financial and staffing challenges have implications for assessing 2023 activity levels beyond the 2022 outturn, and for the HSE’s funding requirements in 2024. In relation to activity levels, it has been assumed that the service developments from NSP 2021 and NSP 2022 which have been fully implemented by the end of 2022 will result in greater activity volumes during 2023; any service developments to be implemented during 2023 are assumed to not impact on activity volumes until 2024.

The Committee discussed plans in relation to retaining the current levels of service and queried whether the scaling and roll out of certain services, giving an example of the Community Intervention Teams (CITs) as one which is not finished, would be continued in 2023. The CSO advised that his understanding was that funding had been secured and good progress made towards the national roll-out of CITs; he agreed to provide a note in this regard to the Committee.

The Committee expressed concern on the financial challenges outlined by the CSO and CFO and recommended the financial challenges are specifically included as risks and issues within NSP 2023. The Committee also requested that reference to population-based planning be strengthened in the NSP, further consideration be given to the CEO’s introduction and also that additional detail should be included in the disability section in relation to its alignment with current models of service e.g. Progressing Disability Services. The CSO agreed that members of the planning team would engage with Committee members individually following the meeting to ensure the feedback and inputs provided by the Committee are addressed in the final Draft NSP. The Committee noted that the timeline of 21 days for the adoption of the NSP is challenging and the Chair will propose to the Board that the planning and engagement process be started earlier in the year in future.

Following further discussion, in particular in relation to the financial and workforce challenges in 2023, the Committee agreed to recommend to the HSE Board the adoption of NSP 2023 on the basis that the approach adopted within the Plan is communicated clearly to the Department of Health. The approach in the Plan is to continue progress with key reforms, with a particular focus in 2023 on ensuring effective service delivery during 3 the forthcoming winter, and improving access to key hospital and community services. Particular issues and risks in 2023 in relation to the financial context within which the Plan has been prepared and the continuing workforce challenges are clearly signalled within the Plan.

The CSO thanked the Committee for the comments and feedback and confirmed they would be addressed in the next draft. It was noted that the final version of the NSP 2023 is due to be adopted by the Board Thursday 10 November and then submitted formally to the Department of Health.

No matters arose under this item.

The meeting ended at 3.35pm.