HSE Safety and Quality Committee meeting minutes 8 September 2023

Committee Members Present

Deirdre Madden (Chair), Fergus O’Kelly, Jacqui Browne, Anne Carrigy, Cathal O’Keeffe, Anne Kilgallen, Mary Culliton.

HSE Executive Attendance

Siobhán NÍ Bhriain (Acting Chief Clinical Officer), Orla Healy (ND QPS), Niamh Drew (Deputy Corporate Secretary), Rebecca Kennedy (Office of the Board), Sharon Hayden (CCO Office), James McGrath (CEO Office).

Apologies

Margaret Murphy, Yvonne Traynor.

Joined the meeting

Bernard Gloster (CEO – Item 3-4), Philip Crowley (ND Strategy and Research – Item 3), Isobel Connolly (Senior Dietitian CHI – Item 4), John Fitzsimons (Paediatric Consultant - Item 4), Gemma Moore (NQPS - Item 4), Fiona Murphy (Chief Executive National Screening Services (NSS) – Item 6), David Keegan (Clinical Director Diabetic Retina Screening – Item 6), Conor Carey (CCO Office – Item 6), Joseph Duggan (ND Internal Audit (IA) - Item 7), Cora McCaughan (AND Healthcare Audit (HCA) - Item 7), Mary Browne (Clinical Lead QPS Education – Item 8), John McIlhenny (QPS Manager Saolta – Item 8), Lorraine Schwanberg (AND Incident Management – Item 8), Maria Lordon Dunphy (AND NQPS – Item 9).

The Committee held a private session where the Chair provided a summary of 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 declarations of interest were made.

2.2 Minutes

The minutes of 14th July 2023 were approved.

CEO and ND Strategy and Research joined the meeting.

The ND Strategy and Research updated the Committee on the National Service Plan 2024 process, focusing on the Estimates (New Service Developments) 2024.

The ND Strategy and Research highlighted the Strategic priority areas underlying the focused approach to new service development (NSD) Estimates bids 2024 and their respective WTE allocations. He advised the next steps in the finalisation of NSD Estimates bids as agreed with the CEO / SLT on 4 September and confirmed an update would be brought to the special Board meeting scheduled for 13 September.

In relation to next steps in the finalisation of NSD bids, the ND Strategy and Research advised that the 2023 financial position allows minimal room for development in 2024. There will be no unfunded posts going into next year unless Minister specifically sanctions them and posts not filled this year will need to be reconsidered as a new proposal for next year.

The Committee emphasised the need to focus on utilising Primary Care posts and discussed the importance of highlighting implementation of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023. The CEO confirmed that more detail could be provided at a later meeting following receipt of the Letter of Determination.

The Committee thanked the ND Strategy and Research and CEO for the update.

ND Strategy and Research left the meeting.

I Connolly, J Fitzsimons, and G Moore joined the meeting.

O Healy introduced I Connolly and J Fitzsimons, advising that they are clinical staff members in attendance to share their experience practicing quality and patient safety work in front line services.

J Fitzsimons presented to the Committee on the QI resources within the National Quality and Patient Safety Directorate that supports the building of QI knowledge and Skill such as the HSE Improvement in Practice programme which the CHI team completed. J Fitzsimons shared his experiences in terms of the opportunities and challenges for embedding QI across our health service.

I Connolly presented to the Committee in relation to her experience as a member of a multidisciplinary team from Children’s Health Ireland who undertook a quality improvement project within their clinical service which was the Introduction of a Post Gastrostomy Device Insertion Feeding Protocol. She advised of the timeline of the project, challenges, measurement of improvement as a result of the project, and sustaining the improvements.

CEO and Chair left the meeting approx. 11:03 with A Carrigy Chairing in D Madden’s absence.

The Committee queried whether QI training is multidisciplinary and to what extent it is integrated into the working day for front line staff. J Fitzsimons confirmed that it is multidisciplinary training but it is an addition to every day work and consideration is being given on how to build it into work more.

Chair rejoined the meeting approx. 11:06

The Committee discussed the value of quality improvement work, thanked I Connolly and J Fitzsimons for attending the meeting and expressed strong support for their work.

I Connolly, J Fitzsimons, and G Moore left the meeting.

CEO NSS and D Keegan joined the meeting.

The CEO of NSS updated the Committee on the National Screening Service, focusing in particular on the Legal Framework Group report and highlighting its recommendations.

The Interval Cancer Steering Group has now completed its work and ongoing governance of the CervicalCheck personal cervical screening reviews (PCSRs) has transferred to the CervicalCheck senior management team.

The purpose of the presentation was to provide information and discussion on report findings, recommendations, next steps, associated challenges, and support required.

Recommendation 10 urges the Government to commence new Part 2A of the Civil Liability and Courts Act, 2004 as a matter of urgency. Recommendation 12 recommends that a further examination with appropriate expert advice, of the feasibility of a non-adversarial alternative dispute resolution process for interval cancers diagnosed as part of participation in population cancer screening programmes. Recommendation 14 recommends the involvement of a Citizens’ Assembly (or a viable independently commissioned alternative, such as a Citizens Jury) to engage debate within society on all aspects of population cancer screening.

The Committee thanked CEO NSS and D Keegan for the work completed to date and it was agreed that the Chair would brief the Board on the recommendations at its next meeting.

CEO NSS and D Keegan left the meeting.

The Acting CCO reported to the Committee on a number of the other areas set out in the report including:

• Children’s flu vaccination campaign
• National Women’s and Infants Health Programme (NWHIP)
• HSE and CHI oversight group
• NDTP summary of vacant consultant posts and locums

J Browne left the meeting approx. 12:05

ND IA and AND HCA joined the meeting.

The S&Q Committee receives a periodic briefing on the work of HCA unit of the IA Division. The ND IA introduced a new system of reporting to the Committee and advised that HCA would now report quarterly rather than twice yearly.

The AND HCA presented to the Committee the HCA report for Q1 and Q2 2023 which had been circulated to the Committee in advance of the meeting. The reports were comprised of the Activity report, Key HCA reports, and Summary of HCA audits. The ANS HCA highlighted issues seen in certain sites including in fetal heartrate monitoring, the management of women with epilepsy in maternity services, the use of review tools to identify the causes of Staphylococcus Aureus Blood Stream Infection, and the prevention of blood clots in hospitals.

The Committee queried the process where a site does not accept recommendations and was advised that if this is the case, local management accept responsibility for the risk and are informed that this will be reported to the relevant National Director. IA are currently working to formalise the risk acceptance process related to internal audit reports.

The Committee sought clarification on the definitions of overall audit report assurance levels, and for these definitions to be included in reports to them going forward. The Committee also sought a supplementary report on the status of recommendations that arose from audit reports that were issued in 2021 and which remained open at 30.06.2023.

The Committee noted the HCA Reports and new reporting schedule.

M Culliton, ND IA and AND HCA left the meeting.

The Committee considered the Quality Profile from the July data cycle. O Healy updated the Committee on the monthly indicators, focusing in particular on CAMHS performance.

She advised that the new Clinical lead for CAMHS is now in place so improvement is expected but this will take time. The Chair confirmed that CAMHS will be the focus of a joint meeting with the Planning and Performance Committee which is due to be scheduled before the end of the year.

M Browne, J McIlhenny and L Schwanberg joined the meeting.

The Committee was presented with an introductory session on Human Factors which provided an update on ongoing work to embed Human Factors into Irish healthcare system in a strategic, sustainable and system-wide approach.

M Browne advised that embedding Human Factors within the Irish healthcare system underpins all six commitments of the Patient Safety Strategy 2019-2024 and is key to empowering staff to deliver safe care. She highlighted the work of NQPS on applying Human Factors as a core part of developing quality improvement and safety capability within the system and advised that within NQPSD, the purpose of the Quality and Patient Safety Education team is to support a culture of continuous learning.

The Committee queried how the learning is rolled out to ensure it can reach as many staff members as possible. M Browne advised that a significant element of their role is building awareness locally in order to draw people towards training.

The Committee expressed their full support for the programmes outlined and thanked the presenters for their time.

M Browne, J McIlhenny and L Schwanberg left the meeting.

M Lordon Dunphy (AND NQPS) joined the meeting.

M Lordon Dunphy presented to the Committee on the work of the Quality and Patient Safety (QPS) Improvement team.

She highlighted how QPS build QI capacity of healthcare staff to align QI with service improvement to enable them to integrate QI into service delivery at national, regional and local levels. This is achieved via QI training, collaboratives, coaching/mentoring, QI project clinics, and using digital technology.

The Committee expressed their full support for the work outlined and thanked M Lordon Dunphy for her presentation time.

M Lordon Dunphy (AND NQPS) left the meeting.

2.3 Committee Meeting Dates 2024

The Committee agreed the meeting dates for 2024.

2.4 Matters for Noting - Health Regions Update

The Committee noted the Health Regions update circulated in advance of the meeting.

No matters arose under this item.

The meeting ended at 15:45.

Terms of Reference: Safety and Quality Committee