Minutes of HSE Board Meeting 30 April 2025

Present

Mr Ciarán Devane (Chairperson), Dr Yvonne Traynor, Mr Brendan Whelan, Mr Aogán Ó Fearghail, Mr Tim Hynes, Ms Anne Carrigy, Mr Matt Walsh, Mr Michael Cawley and Mr Kenneth Mealy

Apologies

Ms Lily Collison

In Attendance for Board Meeting:

Mr Damien McCallion (Deputy CEO / CTTO), Mr Stephen Mulvany (CFO), Mr Pat Healy (ND Services & Schemes), Mr David Walsh (ND Access & Integration), Mr Tony Canavan (REO West & North West), Ms Sandra Broderick (REO Mid West), Ms Kate Killen White (REO Dublin & Midlands), Ms Martina Queally (REO Dublin & South East), Dr Andy Phillips (REO South East), Mr Joseph Duggan (Chief Internal Auditor); Mr Brian O’Connell (ND Strategic Health Infrastructure and Capital Delivery); Mr Patrick Lynch (ND Planning & Performance); Ms Elaine Kilroe (AND Enterprise Risk Management), Mr Mark Brennock (ND Communications), Niamh Doody (CEO Office), Mr Brian Murphy (CEO Office), Ms Sara Maxwell (CEO Office), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Deputy Corporate Secretary), Ms Patricia Perry (Office of the Board).

Joined the meeting

Item 6 - Mr Fran Thompson (CIO), Professor Richard Greene (Chief Clinical Information Officer), Ms Emer Moran (Interim A/CFO Community Finance), and officials from Deloitte Ms Rebecca Ring (Strategic Partner), Ms Fran Cousins (Strategic Partner) and Mr Ger Butler (Director)

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.

1. Declarations of Interest

No other conflicts of interest were declared.

2. Chairperson’s Remarks

The Chairperson provided an update to the Board on a number of matters that would be discussed during the meeting.

3. Ministerial Correspondence

The Board noted the following correspondence.

• Letters to Minister for Health and Minister for Children, Disability and Equality re Corporate Plan 2025 - 2027 dated 28 March 2025,
• Letters to Minister for Health and Minister for Children, Disability and Equality re HSE Draft Annual Financial Statements 2024 dated 31 March 2025,
• Letter from Minister for Children, Disability & Equality re Commission of Investigation (certain matters relative to a disability service in the South East and related matters) (“the Farrelly Commission”) dated 15 April 2025.

4. Minutes of Board meeting

The Board approved the minutes of the Board meeting of 28 March 2025.

1. Audit and Risk Committee

The minutes of the Committee meeting of 07 March 2025 were noted. The Committee Chairperson provided an overview to the Board on the matters considered at the Committee meeting that took place on 11 April 2025.

The Board held a discussion on the following areas:

• The attendance of management at a Committee meeting to explain Internal Audit overdue recommendations in their area,
• Project management reporting to the Board and Audit & Risk Committee in relation to non-pay cost savings,
• Clinical governance and risk, with update by the Chair in relation to a meeting with the CCO and Committee Chairs,
• CCO is drafting a quarterly report on the quality and risk area for submission to the Performance Committee.

2. Performance Committee

The minutes of the Committee meetings of 20 March were noted. The Committee Chairperson provided an overview to the Board on the matters considered at the Committee meeting that took place on 24 April 2025.

The Board held a discussion on the following areas:

• National Performance Report (NPR) for February 2025, noting good progress relative to last year, but some 2025 targets are not being met,
• Staff absence rates,
• Analysis required in relation to the increase in ICT recruitment from 457 in 2018 to 1420 at March 2025,
• The issue of late papers coming to Committee, which needs to be addressed.

3. Joint Meeting of Strategy and Reform Committee and Audit and Risk Committee

It was noted that there was a Joint meeting of the Strategy & Reform Committee and Audit & Risk Committee, with the attendance of Board members held on 25 April 2025 to consider the National Electronic Health Record Business Case, which was to be discussed later in the meeting.

1. Deputy CEO briefing to Board

The Board and the Deputy CEO held a discussion in relation to items raised in the CEO report.

2. CEO Monthly Report

Members of the Senior Leadership Team joined the meeting

The Deputy CEO and Board discussed the use of Insourcing as a sustainable intervention in achieving targets and the Board welcomed the memorandum issued by the CEO to SLT directing a detailed analysis of this.

Discussing Unscheduled Care, the Deputy CEO advised that the performance at the Easter Weekend was very strong across the weekend with the majority of sites Green and in single digit trolleys. The performance overview and comparative analysis was welcomed by the Board, with three particular Section 38 sites having had a strong weekend performance. The CEO and Minister for Health reviewed this with the Hospital CEOs and the relevant REOs together with the three HSE sites, factors such as infection outbreak and specific demand had contributed, but that an improved position over the coming May Weekend was expected.

The Deputy CEO advised the Board that the CEO attended the Cabinet Committee on Disabilities, and had held two extensive engagements with staff of CDNT and related services in early April to explore shared experience in delivering and planning Children’s Disability Services. The Board discussed how improvement agendas have advanced with detail relating to the draft Pay and Numbers Strategy and draft option appraisal of steps that could increase attraction to and retention in Children’s Disability services; and a comprehensive legal opinion on assessment of need (AON).

The Board discussed that AON would benefit from changes in legislation to allow for a preliminary screening before assessment and also that other Government Departments could consider changing their processing of supports to children so as to ensure that AON is not deemed a catch all assessment.

The Deputy CEO reported to the Board that extensive talks in the Workplace Relations Commission aimed at averting industrial action by 80,000 staff were concluded on 30 March 2025, this was welcomed by the Board.

The Deputy CEO and REO West North West provided an update to the Board in relation to a recent obstetric event in respect of Portiuncula Hospital (PUH) (maternity unit). The Board noted that the Patient Safety Protocol has been activated to notify this case to the Department of Health and an update on the status of expected reports regarding PUH (2023 and 2024 incidents).

The Board discussed the Farrelly Commission of Investigation report (Farrelly Report) and noted that this is of significant concern both in respect of the then child care services of the Health Board (now Tusla) and in disability services (now HSE). The Board discussed the steps the CEO has initiated.

The REO Dublin and South East reported to the Board in relation to the assurance that the care and supports required by Grace and the 46 others referenced in the Farrelly Report continue to be a priority. The REO advised that recommendations made from previous reports are being reviewed to ensure that there are no outstanding matters. The Board requested that an update be brought back to the Board in relation to the review of previous reports.

The Deputy CEO reported to the Board in relation to the recent HIQA report into the use of unauthorised and uncertified implants in surgery at CHI, noting that an overall HSE process for implementation of the 19 recommendations has been initiated. The CCO and REO Dublin Midlands provided an update to the Board on two pending reports regarding orthopaedic and spinal work at CHI, both of which are the subject of ongoing deliberation.

The Board discussed the National Children’s Hospital and noted that a meeting of the National Oversight Group chaired by the Secretary General took place on 25 April 2025, and the National Director of Planning and Performance provided an update to the Board. It was agreed that a further report on the commissioning of the NCH be brought back to the Board and the Strategy & Reform Committee.

The Board were provided with an update on the financial position, noting that the focus continues on reducing the challenges around non pay; and noted the update in relation to the governance of Service Level Agreements with Section 38 and Section 39 agencies.

National Performance Report

The monthly National Performance Report (NPR) February 2025 data was presented to the Board. The Performance Committee also reviewed this at its meeting on 24 April 2025.

The Board approved the February 2025 NPR for submission to the Minister for Health, and Department of Children, Disability and Equality, and noted that once submitted, the NPR will be published on hse.ie.

1. HSE Annual Report 2024

Board members adopted the HSE Annual Report 2024, and noted that it may be subject to required editorial amendments during the design and layout process. The Board acknowledged the work of the Planning team. Decision No.: 300425/06

2. HSE Corporate Risk Register Q4 2024 - End of Year Report

The Board approved the CRR Q4 2024 – End of Year Report for reporting in the HSE’s Annual Report. Decision No.: 300425/07

3. HSE Risk Appetite Statement 2025

The Board approved the HSE Risk Appetite Statement 2025. Decision No.: 300425/08

4. Contracts and Properties

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

1. 1. 1. Contract Award for New Specialist Palliative Care Unit, St. Christopher’s Hospital, Loreto Road, Cavan Decision No.: 300425/09
      2. National Direct Drawdown Framework Agreement (NDDFA) for the Supply of Infusion Consumables Decision No.: 300425/10
      3. NDDFA for Supply of Dental Consumables Decision No.: 300425/11
      4. Provision of Renal Equipment and Consumables Decision No.: 300425/12
      5. National Shared Care Record Decision No.: 300425/13

Mr Fran Thompson (CIO), Professor Richard Greene (Chief Clinical Information Officer), Ms Emer Moran (Interim A/CFO Community Finance), and officials from Deloitte Ms Rebecca Ring (Strategic Partner), Ms Fran Cousins (Strategic Partner) and Mr Ger Butler (Director) joined the meeting

1. National Electronic Health Record (EHR) Programme - Preliminary Business Case (PBC)

The Deputy CEO presented to the Board the National Electronic Health Record (EHR) Preliminary Business Case (PBC), which was circulated in advance of the meeting and advised that the Business Case was presented at the Joint meeting of the Strategy & Reform Committee and Audit & Risk Committee on 23 April 2025.

As part of the Digital for Care: A Digital Health Framework (2024 – 2030), the digital health strategic implementation roadmap was developed which advances key Sláintecare Initiatives including the National Shared Care Record programme (NSCR) and the development of a roadmap and investment case for EHR deployment. The Deputy CEO advised that the NSCR and the EHR are complementary and part of a health ecosystem which also includes the HSE patient app and the national diagnostic systems which will be connected to the National EHR.

It was noted that the delivery of a unified, lifetime EHR for citizens is also government policy as set out in the Programme for Government 2025 and the National Service Plan 2025 underscores the necessity for an EHR under the 'Strong Foundations' commitment.

The Deputy CEO advised the Board that although Ireland is currently ranked as the 5th most advanced digital economy in the EU, it lags significantly behind in digital health maturity, and ranked last in digital health readiness among developed nations according to the OECD, which highlights a critical area for improvement. In response to this, the delivery of a single EHR with comprehensive functionality across all of the services was being proposed to the Board.

The Deputy CEO presented the Preliminary Business Case to the Board, which is required for the approval of funding to support this solution. The Board were provided with a presentation setting out the case for change, the proposed solution including the scope of the EHR and the governance, procurement, implementation approach, risk management processes, and full financial and economic appraisal as required under the infrastructure guidelines.

The Board noted that a comprehensive assessment of potential solutions to meet objectives was held which led to the shortlisting of three options for further financial and economic assessment. The Board were advised that a national EHR from a single vendor, delivering a single-instance EHR with competitive functionality emerged as the preferred option, yielding the best benefit-cost ratio and having the lowest risk profile. The Board were advised that from an economic perspective, this option emerged as the most favourable choice, yielding the highest Economic Internal Rate of Return (EIRR) and highest Benefit-Cost Ratio (BCR), driven by its superior economic benefits, and had the lowest risk profile compared to the other shortlisted options.

The Board noted that a detailed risk management strategy was developed outlining the framework for identifying, assessing, and managing risks associated with the programme and discussed the mitigating actions required to manage the risks.

The Board noted that the EHR sets out to deliver a unified, lifetime electronic health record that

empowers patients and care providers to achieve better health outcomes, enhances quality and safety across all health and social care services, and improves their efficiency and agility.

The Board considered and approved the Preliminary EHR Business to progress to tendering and initiate procurement, and for onward circulation to EAP and MPAG and the recommendation within the Business Case, based on the cost-benefit analysis conducted, to progress with the National EHR programme, implementing a single EHR.

It was noted that final Business Case will be brought back to the Board to consider and give final approval to proceed with this programme at completion of the tendering process.

The Deputy CEO advised the Board that the Preliminary Business case has a significant distance to travel now that it is approved by the Board, with consideration at Department of Health, Department of Public Expenditure, Public Service Reform and Digitalisation and Government levels given the scale of proposed investment.

The Board requested that the need for continued assurance as to capability building within the HSE to implement the EHR, if approved by Government, and that any major changes to the Business Case after approval by the Board, will revert to the Board to update the position and decision.

Decision No.: 300425/14

There was no further business. The meeting concluded at 14.45pm.