HSE Planning and Performance Committee meeting minutes 20 October 2023

Committee Members Present

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

Apologies

Tony Canavan (CEO Saolta Hospital Group).

HSE Executive Attendance

Damien McCallion (COO), Mary Day (ND Acute Operations), David Walsh (ND Community Operation), Orla Treacy (Operational Performance and Integration), Dara Purcell (Corporate Secretary), Patricia Perry (Office of the Board).

Joined the Meeting

Mark Brennock (ND Communications - Item 2.3), Dean Sullivan (CSO - Item 6).

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 Committee held a private session to review 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.

The Chair welcomed executive members to the meeting at 9.30am.

2.1 Declarations of Interest

No conflicts of interest were declared.

2.2 Minutes of Committee Meetings

The Committee approved the minutes of 22 September 2023.

2.3 HSE in the News

ND Communications joined the meeting.

The ND Communications provided the Committee with an update on current HSE media coverage, particularly in relation to the recent Budget, the HSE’s current financial position and the political views that have arisen.

The Committee welcomed the recent communications by HSE executives and the CEO outlining to the public the challenge that the HSE is facing with an insufficient budget, and noted An Taoiseach, Tánaiste and Minister for Health’s support of the CEO in presenting his view publicly the challenges faced in running the health services next year.

The Committed discussed the need to simplify the narrative for the public, and would welcome a guide to health funding for members of the public, and outlined that if the HSE does not communicate effectively with the public it could undermine the entire funding approach and the scaffolding that Sláintecare needs.

The Committee received an update in relation to Paediatric Orthopaedic Surgical services at Children’s Health Ireland (CHI) at Temple Street, noting that the External Review has commenced, and an update in relation to the Retained Organs at CHI Crumlin.

The Committee expressed concern that CHI Crumlin Retained Organs situation could still prevail in 2023 and noted that the COO and CCO are engaging with CHI to obtain adequate explanation of the issues involved.

The Safety and Quality Committee is being updated on the matter by the CCO.

ND Communications left the meeting.

The COO Report, HSE Hi-level KPI Report (previously Operational Service Report) (August 2023 Data), Performance Profile (August 2023 Data), National Performance Oversight Group (NPOG) Meeting Notes (August 2023 Data), and an update on the Roadmap for Service Improvement 2023 - 2025 Disability Services for Children and Young People which had been circulated prior to the meeting, were noted.

The Committee thanked the COO and team for the presentation of the new Hi-Level KPI Report. Committee members felt the introduction of the COO Performance Report was welcome.

Members had varying preferences for text and table format in the report but all require key performance messages to be cohesive and clear.

Members agreed that they would consider their requirements further such that they could specify and will meet with the COO to progress.

The COO updated the Committee on the key strategic and operational updates outlined in the above documents, focusing in particular on Scheduled Care, Urgent and Emergency Care, Urgent Colonoscopy, Cancer Services, Therapy Waiting Lists, CAMHS, Disability Services, Resourcing / Pay and Numbers Strategy, Absenteeism, Escalation under Performance and Accountability Framework (PAF) 2023, FORSA Work to Rule and Section 39 Industrial Action.

In relation to Scheduled Care, the COO advised that the total number of patients removed from the OPD, IPDC and GI Scope waiting list was circa 4.7% higher than target with circa 15.6% more patients removed from the waiting list YTD than in the same period last year. He outlined the comparative analysis of access performance across the seven hospital groups based on current performance at end August 2023.

The Committee discussed the achievement of 2023 waiting time targets and were advised that the ND Acute Operations is working closely with all hospitals on W/L targets and has a dedicated access performance monthly meeting.

The Committee highlighted advancements in Clinical Nurse Specialists and Advance Nurse Practitioner roles and requested an update on recent developments in these roles regarding service provision including administration of IV drugs in stepdown facilities and nursing homes.

In relation to Urgent and Emergency Care (UEC), the COO advised the Committee that trends across all Patient Experience Times (PET) metrics are stable. The Committee noted the performance in Letterkenny General Hospital and University Hospital Limerick and were advised that a meeting is to take place with Letterkenny General Hospital. The Committee discussed the performance of hospitals relating to the UEC target that no patient aged over 75 years will wait for more than 24 hours in an ED, and requested assurance that those breaching the target are being followed up and that the Committee are advised of the maximum amount of waiting time for those beyond the target of 24 hours.

The Committee noted the Briefing on the Roadmap for Service Improvement 2023 – 2026, which is to be launched by Ministers Roderic O’Gorman and Anne Rabbitte on 24 October 2023. The version of the Roadmap being published would be circulated to the Committee.

The Committee discussed the Children’s Disability Network Teams, specifically relating to Co Donegal, and the ND Community Operations advised that he has been dealing with this issue with the relevant Chief Officer.

A discussion took place in relation to cross border services and the COO agreed to have it as a possible future agenda item for the Committee.

The Committee noted that the Patient Flow Academy was launched on 16 October 2023, which brought together colleagues from all over the country to hear about a range of issues including driving improvement in the HSE, an introduction to the Patient Flow Academy and the principles of Good Patient Discharge to Improve Patient Flow. The Committee requested that they be informed of any similar events in advance, and the COO agreed to do so and advised that he would provide an update of the event for the Committee.

6.1 National Service Plan (NSP) 2024

Dean Sullivan CSO, joined the meeting The CSO joined the meeting and presented to the Committee the NSP 2024 Initial Pre Letter of Determination (LOD) working draft. The draft was being presented based on previous feedback from the Board and the Committee to avoid an overly compressed time for writing the plan upon receipt of the LOD.

The Committee noted that the HSE Board had held a high level discussion in relation to the NSP 2024 at a Special meeting on 19 October 2023.

The Committee discussed with the CSO the direction of the NSP 2024 noting that the document will be shorter than previous years, while ensuring that all content requirements are addressed and noted that a second, more refined draft NSP 204 will be produced in the coming weeks.

The Committee welcomed that there has been extensive engagement between the HSE and DoH, and that the CEOs of the Hospital Groups and Chief Officers of the Community Health Organisations have also been included in the process. The Committee requested that the next draft be brought before the Committee in the coming weeks.

Older Persons Services

The Committee noted the Older Persons Services papers circulated in advance of the meeting and the National Director, Community Operations provided an update to the Committee on the current position within the HSE.

The Committee noted that the population in Ireland is aging, with the latest population projections indicating a 38% increase in the over 65 population and a 68% increase in the over 85 population by 2031, and noted that the vision for older person services is to deliver increased levels of healthcare with service delivery reoriented towards providing care closer to persons homes.

The Committee highlighted the importance of end-to-end care pathway that will prevent admissions to acute hospitals, minimising hospital stays and improving outcomes, and reducing the number of older people in residential care settings by providing services to people as close to home as possible which will allow our ageing population to maintain their independence and live well in the community.

The Committee discussed the key strategic objectives that must be progressed to reduce the number of older people in residential care settings by providing services to people as close to home as possible which will allow our ageing population to maintain their independence and live well in the community.

These objectives include improving provision of the Nursing Homes Support Scheme (NHSS), continuing to provide new and enhanced integrated models of home and community support; enabling increased access to care and supports in the community, continuing to implement interRAI care needs assessment; and ensuring timely access to dementia care and reduction in waiting times.

The Committee noted that the total budget allocated for Older Person Services is €1.37B in 2023, with initial projections for 2023 end of year indicating an overrun of €74m, noting key cost drivers including Residential Services, Home Support Packages, overtime costs, inflationary pressures and increasing costs associated with clients increasing needs.

The Committee noted that discussions in relation to Older Persons in September 2022 had emphasised the need for a coherent approach across all organisations to develop a national plan for Older Persons Services. The Committee expressed the view that to successfully address the external and internal issues, challenges and risks facing Older Persons Services nationally, input is required from a number of different sectors, providing support across financial requirements, housing, safeguarding and health.

The Committee noted that while ageing is predominantly seen as a health challenge to be addressed by the healthcare system, ageing needs to be seen as a lifelong process and a societal priority.

For this reason, the Committee emphasised that a cross-government, private, community and voluntary sector approach is critical to successfully support our older population to experience healthy, active, and positive ageing.

The establishment of a multi-stakeholder working group across relevant Government Departments, the private and voluntary sector was endorsed by the Committee and would be brought forward to the Board for consideration.

Endoscopy

The update in relation to Acute Hospital Endoscopy Services was deferred and will be presented to the Committee at a future date.

No matters arose under this item.

The meeting ended at 12.40pm.

No private session.

Terms of Reference: Planning and Performance Committee