Oireachtas Joint and Select Committees

Thursday, 23 September 2021

Public Accounts Committee

Financial Statement 2020 and Related Matters: HSE (Resumed)

9:30 am

Mr. Paul Reid:

I thank the Chair and the members of the committee for the invitation to attend this meeting to continue the examination of the HSE's annual report and financial statements for 2020, including grants to section 38 and 39 organisations and SouthDoc. I am joined today by my colleagues, Ms Anne O’Connor, chief operations officer; Mr. Stephen Mulvany, chief financial officer; Mr. Joe Ryan, national director of operational performance and integration; and Ms Mairéad Dolan, assistant chief financial officer.

We submitted information and documentation to the committee in advance of the meeting on the topics for examination, so I will confine my opening remarks to the following concerning section 38 and section 39 services providers. The HSE must use the resources provided to it each year by the Government in the most beneficial, effective and efficient manner to improve, promote and protect the health and well-being of the public. The HSE is mandated in law to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. These services are, by their nature, varied and complex. In the main, the HSE delivers services directly but it also relies on voluntary providers to deliver services on its behalf. It also funds providers to deliver similar or ancillary services.

Section 38 and section 39 service providers comprise more than 2,100 funded and grant-aided organisations nationwide, including some of the large academic teaching hospitals, disability service providers and a diverse range of other health and social care providers. These organisations play a central role in the provision of acute, community and home-based services to the public and many have a long history of caring for patients and service users within their communities. They have been vital and trusted partners of the HSE during the Covid-19 pandemic in protecting, treating and caring for our most vulnerable. I acknowledge and appreciate their enormous contribution to the success of the national health response.

Annual funding released by the HSE to these providers is approximately €5.4 billion. Given this spending, the HSE has a formal governance framework in place with each organisation, incorporating standardised contractual documentation and guidance coupled with direct engagement processes. The governance framework underpins the allocation and oversight of the funding granted and the services provided in return. The requirements of the governance frameworks are onerous on providers, and we know that, and they are also onerous on the HSE. However, such a governance framework is necessary to ensure the HSE and the providers meet their obligations to one another. The terms of a governance framework are informed by the public spending policy and the framework is reviewed and updated in accordance with those principles. The manner in which funding is overseen by the HSE is also informed by the recommendations of the Comptroller and Auditor General. In this regard, I highlight two developments in particular.

First, the large number of service providers, approximately 2,100, funded primarily by the community healthcare organisations, CHOs, led to a decision being taken to establish contract management support units, CMSUs, in each of the nine CHOs. Several of these teams are in place and it is expected that the remaining staff for these units will be in place and the units fully operational by the end of the year. These CMSUs are a dedicated permanent resource and their primary purpose will be to assist service managers at operational level in managing the contractual relationship with the service providers.

Second, as we advised the committee previously, external reviews of the governance of 30 organisations have taken place as part of phase 1 of this process. Phase 2 will commence later this month and it will involve the review of the section 38 service providers not previously reviewed and some of the higher funded section 39 service providers. The purpose of these reviews is to gain external assurance regarding the standards of governance and to ensure that enhancements are put in place where required.

It is important to recognise that our section 38 and section 39 providers are separate legal entities, with their own boards that are directly responsible, in the first instance, for the standards of good governance within their organisations. Most of these providers are registered charities and their boards are subject to oversight by the Charities Regulator, quite apart from any additional governance assurances the HSE may seek.

We continue to work closely with our section 38 and section 39 providers to ensure the services we provide together meet the needs of our communities, are complementary to each other and are of high quality. To this end, we will continue to examine and keep under constant review the governance framework in relation to section 38 and section 39 providers. Some of these organisations are facing funding challenges, and committee members will be aware of this.

The HSE is also participating, with representatives in the voluntary sector, in a dialogue forum set up following the report of the independent review group. The aim of the forum is to build a stronger relationship between the State and voluntary providers for the benefit of patients and service users. It is my view that we need to consider a revised governance framework which better supports accountable autonomy within the sector, while at the same time meeting the important and necessary governance and accountability obligations to which the HSE is itself subject.

SouthDoc provides an out-of-hours GP service to a population of 694,000 in counties Cork and Kerry, in addition to the 3 million visitors to the region each year. There are 502 GP members and the services provided by SouthDoc are governed by a service level agreement which is agreed and signed annually and reviewed quarterly. The agreed level of expenditure for the full year of 2021 is €7.5 million. All calls to the service are processed through a central call centre hub in Killarney in the SouthDoc headquarters. A triage nurse, in consultation with the patient, decides on the most appropriate course of clinical care for the clinical condition. There are 12 walk-in treatment centres as well as seven treatment centres which are attended by appointment only in the SouthDoc catchment area. While some treatment centres were temporarily closed due to safety concerns associated with Covid-19, all patients were still in receipt of a full out-of-hours service, which may have been provided in a different location or via telehealth.

The SouthDoc service continued to operate throughout the Covid-19 pandemic, with necessary precautions applied during the different phases of the public health emergency. SouthDoc introduced medical triage to support normal triage. This allowed for certain issues to be dealt with via telecommunication, where appropriate. There were two specific sites which were later to open, at Listowel in County Kerry and the Blackpool centre in Cork city. Both services were the subject of discussion between SouthDoc and the HSE regarding their restoration, with both centres now open subject to public health measures. The Listowel service recommenced in July and Blackpool recommenced in early September.


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