Minutes of HSE Board Meeting 27 September 2024

Board Member

Mr Ciarán Devane (Chairperson), Dr Yvonne Traynor (Board Member), Mr Brendan Whelan (Board Member), Mr Aogán Ó Fearghaíl (Board Member), Ms Anne Carrigy (Board Member), Mr Matt Walsh (Board Member), Ms Michelle O’Sullivan (Board Member), Mr Tim Hynes (Board Member)

Office of the Board

Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Deputy Corporate Secretary), Ms Patricia Perry (Office of the Board)

In Attendance for Board Meeting

Mr Bernard Gloster ( Chief Executive Officer - CEO), Mr Brian Murphy (Head of Corporate Affairs), Ms Niamh Doody (CEO - Executive Business Manager), Ms Sara Maxwell (Office of the CEO)

Joined the meeting

Mr Damien McCallion (Chief Technology & Transformation Officer -CTTO), Mr Pat Healy (National Director, National Services and Schemes), Mr Stephen Mulvany (Chief Financial Officer - CFO), Mr Tony Canavan (REO West & North West), Ms Janette Dwyer (Regional Director, Service Integration, Mid West), Ms Sara Long (REO Dublin & North East), Ms Kate Killen White (REO Dublin & Midlands), Ms Martina Queally (REO Dublin & South East), Dr Andy Philips (REO South East), Mr Joseph Duggan Chief Internal Auditor CIA (Chief Internal Auditor - CIA)

Dr Colm Henry (Chief Clinical Officer - CCO), Mr Mark Brennock (National Director, Communications & Public Affairs), Mr Patrick Lynch (National Director Planning & Performance), Mr David Walsh (Acting National Director of Access & Integration), Mr Brian O’Connell (Interim National Director Capital & Estates), Mr Joe Ryan (National Director, Public Involvement, Culture and Risk Management), Ms Philippa Withero (AND Human Resources), Dr Mary Coghlan (Director, HSE National Productivity Unit), Mr Gavin O’Neill (AND, HSE National Productivity Unit)

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 Chairperson welcomed members to the meeting and provided an update to the Board during their private session.

2.1 Declarations of Interest

No conflicts of interest were declared.

2.2 Chairperson’s Remarks

The Chairperson provided an update to the Board on the appointment of three new members who will take up their positions effective from 30 September 2024. The Board welcomed the appointments of Mr Michael Cawley, Ms Lily Collison and Mr Kenneth Mealy.

The Chair provided a briefing on his quarterly meeting with the Minister for Children, Disabilities, Equality, Integration and Youth and the Minister for Disabilities, which was held on the 27 June 2024 and noted that his quarterly meeting with the Minister for Health is due to be held on the 30 September 2024.

As had been agreed at the Board’s July meeting, the Committee Chairs had held briefings with their Committees and confirmed that the existing Committees would not continue in their current structure. Committee Chairs discussed the proposal of the new Committee Structures. It was agreed to continue discussions with relevant Board members and develop new terms of references and draft workplans for the new Performance and Transformation Committees. It was also agreed that Board Members Tim Hynes would chair the Transformation Committee and Brendan Whelan the Performance Committee. It was agreed that Yvonne Traynor would chair the Audit & Risk Committee until further discussions and agreement were made. The Board expressed their thanks to all external Committee members who had worked with them over the course of the last five years.

A discussion was held regarding the establishment of a number of Board Task and Finish Groups.

2.3 Ministerial Correspondence

The Board discussed correspondence received from the Minister for Health regarding Medicine Reimbursement Process and Medicines Tracker dated 24 September 2024, and noted that it is being considered by the Chair and CEO and a response will issue to the Minister.

2.4 Minutes of Board meeting

The Board approved the minutes of the Board meeting of 26 July 2024.

3.1 Audit and Risk Committee

The minutes of the Committee meeting of 12 July 2024 were noted.

The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 06 September 2024. The Committee held a discussion in relation to the Supplementary Funding of €1.702bn received and discussed the current cash projections to 30 September 2024 which indicated that expenditure measures within the Health Regions are having limited effect on the cash demands of the HSE. The Committee Chair outlined the Committee’s concerns that if not addressed successfully, it would be significant in respect of the reputation and credibility of the organisation, and that further controls in non-pay would be required to achieve the expenditure control targets.

The Committee reviewed the Plan for the Control Assurance Review Process (CARP) 2024 and agreed to monitor the execution of the Plan. The Committee highlighted their concerns in relation to compliance culture in the HSE and of the importance for an improvement in this area.

An update was provided by the Chief Risk Officer (CRO) in relation to the Q2 2024 Corporate Risk Register (CRR) Report. The Committee discussed the visibility of risks and engagement with Section 38 agencies; noted the high level summary assessment of the risk management framework of the organisation; and welcomed the update on the 50 recommendations proposed by the review of the HSE’s risk management framework which was carried out in July 2021 by John Moody.

The Committee were provided with an update on the draft multi-year implementation plan which had been developed by the Central Compliance Function.

The Chief Internal Auditor (CIA) presented the Internal Audit Activity Report Q2 2024 to the Committee who noted the moderate improvement in the audit ratings, but highlighted their concern that circa 50% remain in the categories Unsatisfactory and Limited.

The Committee discussed the ongoing Internal Audit Industrial Relations matter, and outlined their serious concerns relating to a timely resolution, noting that this matter has been ongoing and that successive attempts to resolve the issue have been unsuccessful.

The Committee discussed the plan for Healthcare audit to transition out of Internal Audit and the proposed reconfiguration from central services by the Chief Clinical Officer. The Committee requested assurance that Healthcare Risk would be on an equal footing with Clinical Risk under the new arrangements.

The Committee noted the update on progress in relation to the Capital & Estates Strategy, and were provided with an update on the Capital Plan 2024.

CEO and Executive Business Manager joined the meeting.

4.1 CEO briefing to Board

The Chairperson welcomed the CEO to the meeting.

Following a request from the CEO to the Chair, three Board members were identified to be in reserve for potential future functions in regard to University Hospital Limerick.

Board members Anne Carrigy, Matt Walsh and Michelle O’ Sullivan left the meeting and recused themselves for the duration of the CEO briefing to the Board on the Report from Justice Frank Clarke.

On the conclusion of the CEO’s briefing, Board Members Anne Carrigy, Matt Walsh and Michelle O’ Sullivan rejoined the meeting.

In response to a query raised regarding registered nurses giving IV antibiotics in nursing homes that they work in, it was agreed that the CEO would set up a meeting with the relevant individuals and Board member to address this.

The CEO provided an update to the Board on the latest position regarding Our Lady’s Hospital Navan (OLHN).

4.2 CEO Monthly Report

Members of the Senior Leadership Team joined the meeting.

The CEO reported to the Board on a number of the key significant areas as set out in the CEO Monthly Report. Focus discussions were held on the following areas:

Discussions were held on progress with the implementation of the Waiting List Action Plan (WLAP) for 2024. The CEO informed the Board that a meeting was held on 23 September 2024 with the Minister for Health.

An overview of the latest position was outlined. The Board noted at the end of August, waiting lists stood at 713k, 30k behind the WLAP target, and the volume of patients waiting were similar to August 2023 waiting lists. Similarly to unscheduled care, scheduled care had also seen increases in demand, beyond all expectations.

The CEO informed the Board that the weighted average wait time of patients on the OPD waiting list reduced from 7.5 months to 7.2 months; an average of 30% of OPD patients have been treated within Sláintecare wait times; and the number of long waiters (>48months) have reduced and remain just under 4,000 OPD patients. Those at risk of waiting over 36 months have reduced by half since January 2024; and the New to Return ratio remains at 2.45 with a mandate since June to reach overall average of 1:2.

The Chair highlighted the importance of senior management and clinical staff using performance data and monitoring to drive efficiency and productivity in OPD activity, the CEO is engaging with each REO to ensure sustained momentum. The Board noted that it is expected that REOs can demonstrate how they are creating a culture of data-led reform across their Regions.

The Board noted that a meeting with An Taoiseach is scheduled for October 2024 to discuss paediatric scoliosis and spinal waiting list. The CEO advised that detailed engagements have taken place with CHI and the REO Dublin and Midlands and outlined his assurance that all opportunities for progress are being maximised.

The Board noted a number of engagements between the CEO and staff and advocates in disability services, and the CEO’s direction that the Special Schools pilot in 6 schools make marked progress before the end of September. The CEO advised that this may create challenges for the resourcing of the respective CDNTs and that he has directed that these areas are to receive enhanced recruitment support.

The CEO informed the Board that the Minister for Health has mandated a new control on Consultant recruitment, specifying that posts will only be approved if productivity compared to 2019 levels can be demonstrated. He advised that teams are working through the implications and available data sources, and that there will be exemptions for those posts and specialities that are not amenable to productivity analysis.

The Board noted that the Pay and Numbers Strategy and associated controls are in place, with July census data demonstrating that DoH related WTE numbers dropped by 103 WTE, and DCEDIY funded posts increased by 395 WTE, with approximately 2.8k WTE within 2024 approved health ceiling. The CEO advised the Board of the approval for the allocation of some 500 WTE to facilitate Agency conversion which is targeted at the double effect of stabilising workforce and reducing costs.

The Board discussed the Financial Position and the Supplementary Funding of €1.7bn received from the Department of Public Expenditure NDP Delivery and Reform and the Department of Health in June. The CEO advised that there are controls, targets and spend limits in place, however the impact of these measures are slow to be achieved in the non-pay area.

The Board outlined that the introduction of further controls in the non-pay profile will be required if limits do not show signs of some achievement in the coming weeks, and noted that the CEO has engaged both the operational and finance leaders of the organisation on this and highlighted the responsibilities on all. The Board outlined their concerns that if not addressed successfully, it would be significant in respect of the reputation and credibility of the organisation.

The Board noted the update from the CEO in relation to the HSE’s Interim Performance and Accountability Framework (PAF), and the new developments that will provide a structured and consistent means of performance reporting at each level of the organisation, with a number of interim measures which have been taken, including a new National Balanced Scorecard, and a new monthly national Performance Report.

The CEO informed the Board that he and Department of Health representatives attended the Joint Committee on Health on the 18 September 2024 on the topic of Productivity and Savings.

The Board noted that the development within the Health Regions continues, with the Integrated Healthcare Area (IHA) managers due to take up post on the 01 October 2024, with the exception of Health Region South West.

The Board noted that across the Regions a period of interim arrangements, extending from 01 October 2024 to 03 March 2025 is required, recognising IHA Managers and Regional EMT are coming into post. REOs are leading this within their respective regions ensuring that services, patients and service users remain safe in the interim while longer term changes are considered and agreed. Proposals have been developed within each Region and are subject to ongoing engagement with staff representative bodies.

The CEO advised that the National Head of Strategic Health Infrastructure and Capital Delivery post is progressing through recruitment.

Board Strategic Scorecard

The CEO confirmed that three scorecards, #3 Primary Care, #17 Health Regions and #18 Climate Action reported a downgrade in their rating, two scorecards #10 QPS and #12 Recruitment and Retention reported an upgrade in their rating, and all other scorecards maintained their rating. The Board approved the Board Strategic Scorecard for September 2024, reflecting June and July 2024 data, for submission to the Minister for Health, and the Department of Children, Equality, Disability, Integration and Youth.

National Children’s Hospital – CHI Operational Readiness and Commissioning Review Update

The National Director Planning & Performance provided the Board with an update on the CHI Operational Readiness and Commissioning Review, the purpose of which was to provide assurance to the HSE and stakeholders regarding the CHI’s preparedness in terms of the programme of work to open and commission the new Hospital. The Board noted the update and that the implementation of the recommendations of the Operational Readiness Review is ongoing and the monitoring of progress will continue through the HSE Lead Director.

4.3 HSE Corporate Plan 2025 - 2028 draft 1

The CEO advised the Board that since the Board’s workshop in July 2024, development of the HSE’s new Corporate Plan has continued, and tabled the first early draft of the Plan for consideration by the Board.

The Board held a discussion and welcomed the direction of travel in relation to the draft, noting the five themes, priority objectives and actions measuring success. It was agreed Board members would provide further feedback to the National Director Planning & Performance and that based on all Board feedback, a second version of the Plan will be brought back for consideration at the October Board meeting.

The CEO left the meeting, and the CTTO deputised as CEO.

5.1 Contracts and Properties

As recommended by the Audit & Risk Committee for approval, the Board considered and approved the following proposed contracts and properties:

1. Cleaning Services for HSE Health facilities Galway Decision No.: 270924/36
2. Contract Award for the Architect Integrated Design Team for the Elective Hospital Programme Phase 1 Decision No.: 270924/37
3. Contract Award for the Project Controls Team for the Elective Hospital Programme Phase 1 Decision No.: 270924/38
4. Contract Award for the construction of St. Josephs Community Nursing Unit [CNU] 43-bed extension Dublin road, Longford Decision No.: 270924/39
5. Contract Award for the construction of St Colman’s New 95 Bed Community Nursing Unit [CNU], Ballinderry Road, Rathdrum, Co. Wicklow Decision No.: 270924/40

The CEO rejoined the meeting.

Dr Mary Coghlan, Director and Mr Gavin O’Neill, AND joined the meeting.

6.1 Productivity & Savings Taskforce Briefing

The CEO advised the Board that further to the Minister for Health’s request for a specific focus on the issue of Productivity at both Department and HSE levels, the Productivity and Savings Taskforce was established in January 2024, co-chaired by the CEO and the DoH Secretary General. The Taskforce brings a focus and leadership to how the health system can respond to the increasing demand for health services, and ensures the optimal amount of patient care is delivered for the funding available.

The HSE National Productivity Unit (NPU) was then established in June 2024, for the next two years and reports directly to the CEO. He outlined that the NPU is the driving force for designing and monitoring multiple measures across the HSE aimed at ensuring the best use of the resources that the HSE has in the public interest.

The CEO introduced Dr Mary Coghlan, the Unit Director and Mr Gavin O’Neill, AND to the Board, who then provided a presentation on the NPU.

Dr Coghlan advised the Board that the object of the NPU is to enable and assure a framework of productivity within the organisation, empowering staff to innovate, leverage and scale data led and evidence based initiatives which optimise the productivity of health and social care service delivery to the public. She outlined at a high level the focus of the NPU, to identify, lead, support, measure and publish on the area of productivity, and the key milestones and deliverables to date.

It was outlined that the NPU’s aim includes leveraging what is known, what has worked well, and the lessons learned from implementation of HSE strategies/plans (including the National Service Plan/WLAP), reforms (Clinical Programmes / Modernised Care Pathways) and the impact they are having on productivity and reducing waiting times. The Board noted that integrating innovation (e.g. through behavioural science, AI etc.) as well as a data centric approach will be key principles underpinning the work of the NPU.

The Board noted that the initial priority focus for the NPU is Acute Outpatient Department (OPD) productivity at site / high volume specialty during Q4 2024 including new service development consultant recruitment, which has been endorsed by the SLT and the Joint DoH/HSE Productivity and Savings Taskforce.

Dr Coghlan outlined five pillars of opportunity types to deliver OPD Productivity Improvement, noting clinical, operational, strategic enablement, strategic innovations and international evidence. She advised that the recent structural changes within the HSE, the Regions and clinical leadership will be critical to ensure the success of productivity improvement.

The AND NPU presented to the Board the OPD productivity governance and operating model and the planned deliverables and milestones across NPU priority workstreams. The Board noted the key milestones and deliverables to end 2024.

The Board welcomed the update and discussed areas that are critical to the success of productivity and savings improvements, and it was agreed that they would return early next year for a further update.

There was no further business.

The meeting concluded at 2.35pm.