HSE Planning and Performance Committee Meeting Minutes 22 March 2023

Committee Members Present

Fergus Finlay (Chair), Brendan Whelan, Anne Carrigy, Sarah McLoughlin (left after Item 2.4), Sarah Barry, Joan Johnston.

HSE Executive Attendance

Damien McCallion (COO), Yvonne O’Neill (ND Community Operations), Robert Kidd (AND Acute Operations), Joe Ryan (ND Operational Performance and Integration), Orla Treacy (Operational Performance and Integration), Dara Purcell (Corporate Secretary).

Joined the Meeting

Caitriona Meehan (AND Communications – Item 2.4), Bernard O’Regan (Head of Disability Operations).

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.

2.1 Declarations of Interest

No conflicts of interest were declared.

2.2 Minutes of Committee Meetings

The Committee approved the following minutes:

• 17 February 2023

2.3 Committee Annual Report 2022

The Committee approved the draft Performance and Delivery Committee Annual Report 2022 circulated in advance of the meeting.

2.4 Committee Effectiveness

The Committee members agreed to each complete the questionnaire circulated in advance of the meeting and return feedback to the Secretary within one week.

2.5 Advocacy Body Presentation for 2023 Meetings

The Committee agreed that members S Barry, J Johnston and S McLoughlin would discuss the structure of these discussions and revert to the Chair and the Secretary with a proposed action.

S McLoughlin left the meeting.

2.6 HSE in the News

AND Communications joined the meeting.

The AND Communications provided the Committee with an update on current HSE media coverage, highlighting in particular the fire in Wexford General Hospital on 1 March 2023. The AND Communications confirmed that each hospital in the country has both internal and inter-agency crisis management plans and communications are a key module of each plan. Although the situation in Wexford is now stable, the challenges of communicating plans for service restoration were emphasised, as was the pressure felt on neighbouring hospitals, particularly University Hospital Waterford.

In relation to the publication of the Executive Summary of Protected Disclosure Investigation at the Phoenix Park Community Nursing Unit, St Mary’s Hospital, the AND Communications confirmed that engagement with the families impacted in advance of the report’s publication was prioritised from a communications perspective. She also advised that the report is overall quite balanced and its recommendations are in line with the Nursing Home Expert Panel Recommendations.

AND Communications left the meeting.

The COO Report, Operational Service Report (January Data), Performance Profile (January Data), National Performance Oversight Group (NPOG) Meeting Notes (January Data), and the PMO Report – Winter/NSP 2022 -23, which had been circulated prior to the meeting, were noted.

The COO updated the Committee on the key strategic and operational updates outlined in the above documents, focusing in particular on the National Screening Services (NSS), Unscheduled Care (USC), and Scheduled Care. In relation to NSS, the COO advised that recruitment/retention of radiography and radiology staff continues to be critical to the operation of BreastCheck and is being actively managed. He advised that CervicalCheck performance has stabilised and is operating within standard performance measures. The National Cervical Screening Laboratory (NCSL) project to build, equip and operationalise a new laboratory will conclude successfully in Q1, 2023. An oversight group will be established to provide senior leadership for all aspects of the working relationship between the NSS and the Coombe Hospital in relation to laboratory services for CervicalCheck once the NCSL steering group closes in March. The Diabetic Retina screening programme is performing well overall however ongoing issues and challenges continue to be managed at the treatment centre in Cork University Hospital.

In relation to USC, the COO advised that although some winter pressure eased in EDs, it remains a difficult period. Overall hospital performance (quality, access, integration) and sites of concern are being tightly monitored and Safety Metrics will be examined to see what is suitable for reviewing performance in ED’s. The Committee discussed the impact of lack of availability of GP appointments on ED services and the possibility to expand the role of healthcare professionals in GP practices to alleviate this. The COO agreed to bring a paper on GPs and supporting disciplines to the next Committee meeting. The COO confirmed that the USC multi-year plan is under development with stakeholder engagement ongoing and that while the plan would be informed by the Department of Health capacity review, the HSE is also utilising in-house public health knowledge in development of the plan with the intention to have internal capacity to re-fresh the plan as required. The Plan is due to be completed by mid-year.

The Committee queried the broad parameters of some metrics used in the Performance Profile and asked that further context be provided in some instances. The Committee discussed in particular the ED waiting times for over 75s, querying the mitigating factors implemented to address these times. The COO advised that a range of interventions which are impactful in certain hospitals are currently considered for wider roll out and effectiveness will be site-specific.

In relation to scheduled care, the COO advised that a close out report for 2022 is being compiled in conjunction with the DOH; funding letters for 2023 have issued to hospitals to provide approval to progress initiatives; and Community Operations proposals have been completed. He highlighted that 2023 waiting list numbers to date are not on target which can somewhat be attributed to January winter pressures. The Committee queried whether there is a timeline by which improvement is expected to be seen. The COO confirmed that clinical pathways are a priority in this regard and a report on this will come to the Committee at the end Q1 2023.

The COO also presented data on Urgent Colonoscopy, Cancer Services, Psychology, Child Health and Ophthalmology which was noted by the Committee.

B O’Regan joined the meeting

The Committee noted the Disability Services deep dive paper circulated in advance of the meeting which is due to be presented to the Board as a Strategic Focus item at its March meeting. The paper covers the following in relation to Disability Services:

• statement of strategic objective for the HSE/link to ministerial priorities in current year
• population/Service Profile/Service Plan
• future need
• service governance model national and local: Legislative, Policy and Strategic Context for Specialist Disability Services
• current service delivery status/analysis
• risks, issues and challenges
• key performance indicators (KPIs) / targets and current performance
• future implications for other strategic priorities / service plan
• the approach to stakeholder management

It was agreed that any further feedback from the Committee should be forwarded to B O’Regan for incorporation into the paper prior to its submission to the board.

B O’Regan presented the updated Roadmap for Service Improvement 2023 - 2025, advising that this draft reflects the feedback received from the Department of Health and the Minister. The Committee discussed the changes made in the current draft.

The Committee queried the level of patient partnership undertaken in the drafting of the Roadmap. B O’Regan confirmed that in addition to the patient advocates on the Committee, family forums provided feedback which informed development of the document. The Committee queried whether the HSE National Patient Forum would be engaged with before the Roadmap is submitted for Board approval. The COO advised that this engagement would be sought following the Roadmap’s approval and during its implementation stage and he will meet with Committee members to agree on the approach to this engagement if requested.

In relation to the Assessment of Need (AON) process, the COO confirmed that Fórsa have approved the revised clinical guidance for assessors involved which will now facilitate implementation, standard practice and oversight. Private capacity will be considered to enhance resources available to complete assessments. The Committee noted that the HSE will undertake a focussed consultation in April 2023 with families, staff and other stakeholders to develop a proposal for balancing the competing demands of the AON and intervention when resources are limited. The Committee discussed feedback regarding requirement for revision of the Act and the COO advised that this would be raised with the DOH.

The Committee advised that the next version of the Roadmap should be accessible and readable from a public perspective e.g. inclusion of a glossary, explanatory infographics and provision of a plain english version. The ND Communications confirmed that HSE Communications are currently engaged in this draft and these changes will be implemented in the next draft.

The COO advised that he would be happy to receive further comments from the Committee and will incorporate them into the next draft. The Committee thanked the COO for work completed to date and expressed their strong support for the proposed process. It was agreed that the Roadmap should be submitted to the Board for approval this month if possible.

B O’Regan left the meeting.

The COO presented the updated Performance Accountability Framework (PAF), advising that the PAF will need further revision to support the new RHAs in 2024. The most significant changes to the PAF in 2023 are:

• health System Performance Assessment Framework text has been included to demonstrate the National direction of performance and accountability
• national Performance Oversight Group (NPOG) membership has been revised reflective of new organisational structure following the National Corporate Centre Review in 2021
• the levels of escalation has been increased to five, adding, at Level 3, escalation by National Directors under a revised ruleset:-
• a national variance of 20% from plan, and/or
• persistent performance issue, and/or
• strategic issue
• new Operational Oversight Group arrangements for un-scheduled and scheduled care have been added. The output from these groups will be available for the NPOG meetings
• additional monthly reports on un-scheduled and scheduled care will be compiled reporting on performance at national and service delivery level. Reports will identify strong and poor performance by service entity against NSP targets and reports will be shared with the Department of Health and the Minister
• the Board Strategic Scorecard development has been added which provides updates on progress against key Programmes/Priorities and is provided for approval to the HSE’s Board and shared with the Department of Health and the Minister on a monthly basis

It was noted that the PAF may need a further update to take into account planned changes to disability services discussed earlier in the meeting as they are implemented.

The Committee queried whether there is good broad alignment with other HSE performance reporting documents which the COO confirmed there is. The COO advised he is happy to take further Committee feedback via email.

The Committee noted the updated PAF and suggested that it also be brought to the People and Culture Committee for noting.

The Committee noted the draft Annual Report 2022 and the timelines and process to finalise it outlined in the papers circulated in advance of the meeting. It was agreed that a special Committee meeting may be held in April if required to review the Annual Report prior to its submission to the Board for final approval on 26 April 2023.

No matters arose under this item.

The meeting ended at 13:00.