Minutes of Special HSE Board Meeting Wednesday 13 September 2023

Present:

Mr Ciarán Devane (Chairperson), Prof Deirdre Madden, Mr Brendan Whelan, Mr Fergus Finlay, Dr Yvonne Traynor, Ms Anne Carrigy Dr Sarah McLoughlin, Prof Fergus O’Kelly, Ms Michelle O’Sullivan and Mr Matt Walsh

Apologies: Mr Tim Hynes and Mr Aogán Ó Fearghaíl

In Attendance for Board Meeting:

Mr Bernard Gloster (CEO), Mr Dean Sullivan (CSO), Mr Stephen Mulvany (CFO), Mr Damien McCallion (COO), Dr Colm Henry (CCO), Dr Philippa Ryan Withero (AND Human Resources), Mr Fran Thompson (CIO), Mr John Ward (CTTO), Mr Mark Brennock, (ND Communications ), Dr Philip Crowley (ND Strategy & Research), Mr Pat Healy (ND Clinical Programme Implementation & Professional Development), Mr David Walsh (ND Community Operations), Dr Stephanie O'Keeffe (ND Operations Planning), Ms Miin Alikhan (AND National Strategy and Research), John Delamere (AND), Dr Risteard O’Laoide (AND), Mr Brian Murphy (Head of Corporate Services), Niamh Doody (CEO Business Manager), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Deputy Corporate Secretary), Ms Patricia Perry (Office of the Board)

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.

1.1 Declarations of Interest

No conflicts of interest were declared.

1.2 Chairperson’s Remarks

The Chairperson welcomed Board members, CEO and Executive members to the meeting.

The Chair advised the Board on the current update in relation to the recruitment process for the CTTO position, and noted correspondence had been received from the Minister for Health in relation to the Child and Adolescent Mental Health Services (CAMHS), which would be circulated to the Board.

The Chairman invited the CEO to provide an overview of the papers setting out the estimated financial cost in 2024 for Existing Level of Services (ELS) and National Service Developments (NDSs), which had been circulated to the Board prior to the meeting for review and consideration.

The CEO informed the Board that the preparation of the Estimates incorporates two elements: an estimate of funding requirements for an Existing Level of Service (ELS) for 2024, led by the CFO and an estimate of requirements for key New Service Developments (NSDs) for 2024, led by the CSO. He advised the Board that both papers were being presented to agree the approach being taken in finalising the 2024 Estimates submission to the Department of Health (DoH). He outlined that this was an important input to the DoH Estimates process including their engagement with DPER around the setting of the 2024 Health Vote, and ultimately the National Service Plan 2024.

The CEO advised the Board that the key priority for 2024 is to reduce the level of financial risk being managed by the HSE and therefore the priority is to get the existing level of service (ELS) fully funded to the greatest extent practical and thereafter consider further development to the service via New Service Developments (NSD). A key element of this is the Financial Control Framework 2023, whose primary objective is improving access to quality services by delivering on the planned capacity, activity and access times set out in the National Service Plan, while operating within the available budget. This will remain a key financial management priority for 2024. Significant additional recurring funding will need to be secured, to maintain existing service levels and this will be a priority over the development of new services.

2.1 Estimates - Existing Level of Service (ELS)

The Board was presented with an overview of the Estimates for ELS for 2024 by the Chief Financial Officer (CFO). The CFO firstly briefed the Board on the 2023 forecasted deficit, based on Q2 results. He advised that the financial outlook is showing a year end deficit range of between circa €1.7bn and €2.0bn excluding the 1st charge of €185m, compared to the National Service Plan 2023 risk of up to €2.2bn.

The Board noted that the ELS 2024 bid has two high level components: ELS 2024 – Deficit 2023, recurring unfunded costs arising in 2023 or prior years that are not already funded; and ELS 2024 – Incremental costs 2024, additional costs that are expected to arise in 2024, not otherwise funded.

The CFO confirmed that the preparation and submission of the overall ELS bid for 2024 is an iterative process with preliminary drafts of components shared with the DoH in early August. He advised that discussions on the current draft ELS bid between the DoH and HSE shows that they are reasonably aligned around the approach albeit significant work is underway to narrow the gap between the current HSE and DOH draft ELS figures. The CFO also noted that while efforts are continuing to reduce the 2023 deficit, supplementary funding to year end will be required and the challenge is to secure as much as possible as recurring funding. The Board welcomed the ongoing engagement between the DoH and HSE to arrive at an shared understanding of the funding position to end 2023 and for 2024.

2.2 Estimates - New Service Developments (NSD)

The Board were then presented with an overview of the Estimates for NSDs for 2024 by the National Director Strategy & Research who presented the key messages from the briefing paper and presentation circulated prior to the meeting. He advised the Board that a new approach was agreed for the 2024 planning process in the context of the significant financial and operational constraints, and to ensure a co-ordinated planning process. A National Planning Group and Executive Management Team Planning Sub-Group was set up to guide a unified approach to national planning, and the ND SR outlined the key decisions, and agreement of 8 Strategic Priority Areas and milestones to date.

The Board noted that the 2024 starting position is oversubscribed with a projected recruitment carry over of circa 7,400 WTE posts, which includes not yet onboarded posts approved in previous years’ service plans and winter plans, a percentage of which are not specifically full year funded. It was also noted that the recruitment carry over into 2024, (i.e. posts approved in previous years’ service plans and winter plans, not yet finalised) will greatly exceed the forecasted market supply of circa 6,500 WTE that are available for recruitment in any given year and before any additional NSD needs are considered for 2024.

The ND SR briefed the Board on the requirement for the HSE to plan for workforce growth of 3,000; 4,500 and 6,000 WTE scenarios in 2024, but at present are working towards a possible net growth figure of 5,100 new posts (600 of which are under the Disability Action Plan).

The Chairman of the Planning and Performance Committee reported that the Committee had not reviewed papers prior to the Board meeting, and it was agreed that a further engagement with the Committee would take place before the final figures are submitted to the DoH.

The Board considered the challenges in preparation of the Estimates 2024 noting it is more complex than in previous years, given financial pressures on government, residual challenges around recruitment and retention and the expected inflationary pressures which will materially impact the economy overall. The Board welcomed the ongoing discussions with the HSE and the DoH, and noted that they are reasonably aligned around the approach to be taken.

The meeting concluded at 6.15pm and was followed by a closed session for the CEO with the Board.