Sarah Cremin - Dáil Éireann · 2019. 3. 13. · John Pollock, Project Director, NPHDB (JP) Apologies: Rosarii Mannion, National Director of Human Resources, HSE (RM) Richard Corbridge,

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Sarah Cremin

From: Ray Mitchell <[email protected]>Sent: 07 February 2019 13:00To: Patrick Fannin; Public Accounts CommitteeCc: [email protected]; '[email protected]'

([email protected])Subject: FW: CHP&P Steering Group minutesAttachments: CHPP 170526 Programme Project Steering Group (notes 260517 for

circulation).pdf; CHPP 170829 Programme Project Steering Group.pdf; CHPP 171020 Steering Group Meeting FINAL Minutes.pdf; CHPP 171122 Steering Group Meeting Minutes v0.4.pdf; CHPP 180125 Steering Group Meeting Draft Minutes v2.0.pdf; CHPP 180226 Steering Group Meeting Minutes V2.0.pdf; CHPP 180326 Steering Group Meeting Minutes V4.0.pdf; CHPP 180423 Steering Group Meeting #8 Minutes V1.0.pdf; CHPP 180531 Steering Group Meeting final.pdf; CHPP 180625 Steering Group Meeting issued.pdf; CHPP 180827 Steering Group Meeting v2 final.pdf; CHPP 180924 Steering Group Meeting v02 final.pdf; CHPP 181022 Steering Group Meeting #13 final.pdf; CHPP 181210 Steering Group Meeting #14 final.pdf; CHPP 170526 Programme Project Steering Group (notes 260517 for circulation).pdf

Dear Pat, I understand that the PAC have requested the minutes of the Childrens Hospital Programme and Project Steering Group (CHP&P). Please find attached copies of the minutes as requested for the information of the Committee. (Just for clarity these are the minutes that Dep. Kelly had requested and received separately). With kind regards, Ray Mitchell HSE Parliamentary Affairs Division 01 6352531

CREMINS

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PAC32-R-1939(i) B Meeting 14/02/2019

Children's Hospital Programme and Project (CHP&P) Steering Group Meeting

26th May 2017 at 9.30am

Room 2.21, Dr Steevens Hospital

Attended by:

Liam Woods, National Director of Acute Hospitals, HSE (Interim Chair) (LW)

Helen Byrne, Head of Planning & Performance, Acute Hospitals, HSE (HB)

Eilish Hardiman, Group CEO, CHG (EH)

Aine Carroll, Director Clinical Strategy & Programmes, HSE (AC)

Stephan Mulvany, Chief Financial Officer, HSE (SM)

Jane Carolan, National Director of Health Business Services, HSE (JCa)

Joe Ryan, Acting Head, Programme for Health Services Improvement (JR)

Greg Dempsey, Assistant Secretary Finance, DOH (GD)

Tracey Conroy, Assistant Secretary Acute Hospitals Policy, DOH (TC)

Fionnuala Duffy, Principal Officer, Acute Hospitals Policy, DOH (FD)

John Pollock, Project Director, NPHDB (JP)

Apologies:

Rosarii Mannion, National Director of Human Resources, HSE (RM)

Richard Corbridge, Chief Information Officer, HSE (RC)

Muiris O’Connor, Assistant Secretary R&D and Health Analytics, DOH (MO’C)

1 – Introductions and Welcome

The meeting was chaired by Liam Woods. John Connaghan (JCo) to chair the meetings following

appointment on 1st August 2017.

2 – Decision Making Framework / Steering Group Terms of Reference and Membership

Terms of Reference were discussed and agreed.

Action: Amendments to be submitted prior to the next meeting. Memo to the Government agreed

key elements of approved decision by Government and outline to be shared with steering group.

The Children’s Hospital Group, Development Board Project Team and HSE National Directors to

provide relevant reports to the CHP&P Steering Group. These will be subject to discussion and

decision making at future meetings.

3 – Children’s Hospital Programme

(a) Children’s Hospital Programme Dashboard

Children’s Hospital Programme dashboard was tabled and discussed. Interdependencies outlined

between capital project, national Model of Care for Paeds, national EHR project and workforce plan

for CHG.

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PAC32-R-1939(ii) B Meeting 14/02/2019

DRAFT NOTES_Children's Hospital Programme & Project Steering Group Meeting

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The Paediatric Model of Care needs an implementation plan and it was noted that there are

implications for other divisions also.

Action: EH to lead for the Acute Division initially and will also require financial input.

Action: Paper required to inform on the financial implications of implementation.

Draft Heads of Bill for the CHG to become a legal entity is expected to go to Cabinet at the end of

June.

Future Operating Model under development in order to set-out how the Children’s Hospital with

two satellites will operate from 2021 onwards.

Action: Milestones and timelines of the project and programme will be key discussion items at all

future meetings.

It was noted that SAP-HR implementation in the CHG needs to be added to the milestones.

High Level Risks discussed – issues around resourcing, decision making between this Steering Group

and the CHP+P Board, from ICT perspective the national roll-out of MedLIS and National EHR are

risks.

(b) 2017 Funding Deficit Children’s Hospital Programme / Estimates Process 2018

For 2017, the integration programme has a deficit of €4.6m and this is impacting on its

implementation. The shortfall was originally €8.6m however the CHG have re-profiled some of the

work scheduled for 2017 to 2018. The impact of the deficit will start next month.

The reconfiguration of outpatient and urgent care services and expected opening of the Connolly

satellite in 2018 will require recruitment of difficult to fill posts to start mid-late 2017.

Action: JP to provide 3 year and dependency estimates.

Action: The CHG need to clearly set-out the costs associated with ICT/integration programme in the

estimates for 2018.

Action: EH to progress paper on difficult to fill posts with RM.

(c) Children’s Hospital Programme ICT Dependencies

ICT have 17 projects across the CHG for the Paeds Outpatient and urgent care centres at Tallaght

and Connolly. These are integration projects on-going across hospitals and a due diligence process is

underway to support commencement of the new legal entity. There is an executive arrangement in

place with St. James’s Hospital on shared campus infrastructure and associated services.

Action: Report at next meeting on the Value Engineering Report.

Discussion on need for an Integrated PMO approach to map the interdependencies between the

capital project, implementation of the National Model of Care for Paeds, National EHR, workforce

and Integration Programme. LW/JP/JR/EH to revert with proposal for Integrated PMO.

Action: Project Management Office to be integrated and EH to develop a straw-man.


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The decision with regard to MES is outstanding as it is unclear who the stakeholders are and who will

be signing-off on it.

Action: GD to follow-up and ascertain who in DPER to engage with to progress.

Action: SM to submit Crowe Horwath report to DOH and circulate to members of this Group.

In relation to the ICT Business Case - MedLIS – programme delivery date for national roll-out is

challenging. SM concurs and project under intensive oversight by HSE, progress with programme to

be monitored closely.

(d) Paediatric Outpatient & Urgent Care Centre Resourcing (Connolly)

Paper on Workforce Plan to open paediatric outpatient and urgent care centre at Connolly included

with papers. Connolly requires approval to progress the start of recruitment of difficult to fill posts

in last quarter 2017. There are a total of 31 post identified in 2017 in this category. There is a long

lead in time to get the staff in place.

Action: EH to progress paper with RM for DoH consideration. Approval is required to progress.

National Model of Care for Paediatrics: There is to be a follow up meeting with the Paediatric Clinical

Programme Leads and EH. Resource requirements need to be set out for implementation. Aine

Carroll and Liam Woods to discuss. It is intended that a group will be set up to oversee the Model of

Care implementation with input from all relevant divisions

Action: DOH to lead on discussion with DPER on the implications of the Model of Care.

5 – Children’s Hospital Project

(a) Construction Contracts Update

Decision made by the Government on 26th April. The commercial and contract engagements are to

commence in the next week.

Action: Indemnity for the NHDB needs to be addressed. Construction contracts are expected to be

signed in early June. GD to follow-up re indemnity.

JP to revert with updated Programme on contract signing.

Fire Cert – There has been a condition attached into the building regarding sprinklers. The NPHDB

are appealing these conditions with An Bord Pleanala as it would increase costs. An appeal will be

lodged and notification of the outcome expected towards year end.

(b) Tallaght Hospital ICT Server Room

Paper included with agenda outlining urgent requirement to resolve €2m HSE funding for Phase 1

works to move ICT server at Tallaght Hospital. Satellite build is due to commence in August and

solution on server move required.

Action: JCa to follow up with RC to progress solution.


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6 – Agreed Meetings Schedule

To be decided upon after the Governance Board set their meeting dates. It was considered

preferable to meet monthly for the forthcoming months and then move to every 6 weeks. It was

also suggested that these meetings take place before the Board meetings.

Children's Hospital Programme and Project (CHP&P)

Steering Group Meeting

29th August 2017 at 1.15pm

Boardroom, Hawkins House, Dublin 2

Attended by: John Connaghan (JCo), Deputy Director General, HSE (Chair) Liam Woods (LW), National Director of Acute Hospitals, HSE (Interim Chair) Tracey Conroy (TC), Assistant Secretary Acute Hospitals Policy, DOH Eilish Hardiman (EH), Group CEO, CHG Aine Carroll (AC), Director Clinical Strategy & Programmes, HSE Stephan Mulvany (SM), Chief Financial Officer, HSE Jane Carolan (JCa), National Director of Health Business Services, HSE Greg Dempsey (GD), Assistant Secretary Finance, DOH John Pollock (JP), Project Director, NPHDB Helen Byrne (HB), Head of Planning & Performance, Acute Hospitals, HSE Muiris O’Connor (MO’C), Assistant Secretary R&D and Health Analytics, DOH Audrey Doyle (AD), General Manager, Office of the National Director of HR, HSE Siobhan Keenan (SK), Acute Hospitals Policy, DOH Roisin Mulqueen (RMu), Acute Hospital Division, HSE Deirdre Love (DL), Acute Hospital Division, HSE Apologies: Joe Ryan (JR), Acting Head, Programme for Health Services Improvement Rosarii Mannion (RMa), National Director of Human Resources, HSE Fionnuala Duffy (FD), Principal Officer, Acute Hospitals Policy, DOH Richard Corbridge (RC), Chief Information Officer, HSE

1 – Introductions & Welcome The meeting was chaired by John Connaghan (JCo).

2 – Minutes/Matters Arising Action: Update required from Rosarii Mannion (RMa) re paper submitted by Eilísh Hardiman (EH) on approval for difficult to fill posts, for opening first facility. Action: Integrated PMO to be in place by the next meeting (Joe Ryan, JR). Action: Reporting Framework required for CHP&P Board (Tracey Conroy, TC).

3 – Children’s Hospital Programme Dashboard EH provided an update on the major milestones for the Children’s Hospital Programme for the next year – overall programme is in amber status due to DG Letter to Chairman on 2017 funding deficit and lack of clarity on progression of National EHR. The publication of the Heads of Bill (29/08/2017) was noted. Action: HSE feedback on Heads of Bill to go to Liam Woods (LW). It was noted that pre-commencement analysis and review of the 3 hospitals mergers (due diligence/risk assessment) is in progress and will require engagement with Liam Woods.

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PAC32-R-1939(iii) B Meeting 14/02/2019


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Workforce - Difficulty in filling a number of posts was noted (e.g. ICT Infrastructure Lead at Assistant

National Director grade – currently embarking on 3rd attempt to fill the role – due to highly competitive market. )

- Issues of the sustainability of an over-reliance on External ICT support were also discussed. - Approval to recruit required asap. - Paper submitted with meeting documentation regarding the permanent filling of executive

posts for the CHG being progressed due to commencement of entity. It was noted that there is a funding deficit of €3m to year end in relation to the Children’s Hospital Integration Programme. EH/LW and SM to meet. The greatest dependency is on the National Electronic Healthcare Record (EHR) - Pre-procurement work on specification progressing with assurance required on EHR

programme. - MedLis timeline is a risk within the healthcare system. Action: Monthly report on MedLis required. Update report on EHR requested from RC Key Dependencies of the Children’s Hospital Programme - National EHR – the New Children’s Hospital will be the first to roll-out EHR in the acute sector. - Funding – Proposals have been submitted for 2018 estimates. - Legislation enacted in Q4 2017 to allow commencement and transition of the three hospitals

into a single entity. Draft General Scheme published – opportunity to review draft for the 2 next weeks.

- Workforce – Approval required in recruiting staff for opening Paediatric OutPatient and Urgent Care Centre at Connolly.

Staff engagement – EH advised that the Joint Information and Consultation Forum was presented to in Q2 2017. EH advised that meeting with National Leads arranged for October 2017 and briefings arranged for the three hospitals. Clarity has been sought in relation to Senior Management roles / variations to roles. It was noted that there are supports available to staff (e.g. Occupational Health) and an Organisational Development plan re people and change. Expectations in market rates are impinging the ability to recruit appropriately experienced/qualified staff, in particular ICT senior positions.

4 – 2017 Funding Deficit Children’s Hospital Programme/Update of Estimates 2018 It was noted that the 2018 estimates have been submitted, which have been escalated to DPER as a priority. Action: Meeting to be scheduled between LW, EH and Stephen Mulvany (SM) to discuss 2017 funding deficit. Closed.

5 – Workforce: Approvals for Commencement Executive Roles Paper circulated with Agenda by EH. Executive posts are currently filled on a temporary basis with exception of CFO post, approval sought for these to be filled on a permanent basis – through external advertisement. EH to progress required Business Cases for these executive posts without previous approval.


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The proposal is to develop a cross city arrangement structure over a two year period that will involve the re-alignment of hospital executive posts in a phased manner. Action: EH to commence approvals process with HSE and Dept. of Health for unapproved posts.

6 – Update of Programme for Capital Projects Report circulated by John Pollock (JP). - JP advised the group that the construction contract for the National Children’s Hospital (NCH;

Phase A) with BAM was signed last month. A 52 month construction period is anticipated plus 2 months contingency. The start date is anticipated to be 2nd October 2017, with completion due by the end of Q1 2022. There will be a 6 month commissioning period thereafter with the expectation of being operational by the end of Q3 2022. It was noted that there are 2 phases for the NCH – Phase A basement level (15-18 months) and Phase B above ground works.

- The contract for the 2 satellite centres (Phase B) is due to be signed 30/08/17. Estimated completion of Connolly centre is end of May 2019, with a 2 month commissioning period – due to be operational by the end of July 2019. Estimated completion of Tallaght centre is end of April 2020, with a 2 month commissioning period – due to be operational by the end of June 2020.

Action: SM/JCo requested an update at every meeting regarding the expected vs current programme of the construction project, with funding streams and interdependencies to be included. EH and JP will provide until the PMO is assigned. There is a plan in place for the relocation of Server at Tallaght. As this is an important dependency it was agreed that the plan required a written update on progress for the Steering Group Meetings. Action: RC to nominate an alternative representative to make provision for update on issues at meetings. Action: TC requested a report of slippages since April ahead of the Governance Board meeting on 14th September. A query was raised in relation to the future reporting agenda. The importance of making plans and implementing Primary Care Teams in the Communities around the vicinities of the current hospital sites was noted. Dashboard report circulated by JP which gave an update on construction Health & Safety, Tallaght server relocation and completion of Aspegillus works at Connolly. Action: Update required from Richard Corbridge (RC) for the Governance Board meeting on 14th September in relation to Tallaght server relocation. Action: Alternative ICT representative required. It was noted that settlements have been agreed for the residents of O’Reilly Avenue. Main construction to commence on 2nd October – 5 day working week with planning permission to work a half day on Saturdays if required as contingency arrangement. The NCH construction programme project has been benchmarked against similar projects in the UK and compares favourably (month/1,000 sq.m). Construction of Phase A of the project to be tracked as a KPI.


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It was noted that the project incorporates a Frozen Design Layout and changes only considered through the identification of commensurate savings elsewhere. JP raised a concern regarding costs – it was noted that there is an aligned programme issue between mechanical/electrical work and main contractor as well as fire certificate/sprinklers additional requirements – to be reported to the group on a regular basis. Guaranteed Maximum Price (GMP) to be agreed with BAM at the end of the GMP process and will be known within the next 7-9 months. It was advised that €65m for Managed Equipment Services (MES) has been identified, €20m approx. for standard capital. A Steering Group has been established – JP, HSE, Dept. – in relation to approvals. It was noted the MES is a first for Ireland and will be challenging in relation to approvals process. A query was raised in relation to the cut-off date regarding a decision to proceed with MES option – JP to revert. The Business Case needs to be accurate with regard to how we measure value.

7 – ICT Dependencies Action: Update required from RC regarding Tallaght alignment server alignment between National EHR and the Children’s Hospital opening. Muiris O’Connor (MO’C) advised that there is an opportunity of securing funding for National EHR though Sláinte Care implementation. It was noted that contingency planning undertaken in this key dependency.

8 – Implementation of Paediatric National Model of Care Aine Carroll (AC) advised the group that a sub-group met recently – 0.5 wte project management post in place. TC noted that an implementation plan is required as soon as possible detailing how the Implementation of the Acute Hospital’s Model of Care including how it will integrate with Primary Care. LW stressed the import of dependency on the role out of the Model of Care on a national basis in particular that services in Galway, Limerick and Cork need to be developed in line with the national programme also. Immediate requirements to develop the implementation action plan have been submitted to the 2018 estimates process.

Action: AC to update next meeting with estimated timescale to develop the implementation plan.

9 – Agreed Meeting Schedule It was agreed that the meetings would take place on a monthly basis. Integrated PMO to schedule meetings between now and the end of Spring 2018.

10 – AOB Dublin 8 Health and Innovation Corridor

- Multi-stakeholder group (Children’s Hospital, Coombe, St. James’s, IDA and Dublin City Council) re urban regeneration to include health and innovation corridor due to meet on 5th September – update to be provided at the Governance Board meeting on 14th September.

Philanthropy

- Philanthropy campaign required, follow up meeting with three hospital Foundations being planned for October 2017.

- No funding acquired for the Research Building

Children’s Hospital Group Programme & Project Steering Group

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Meeting Children’s Hospital Programme & Project (CHP&P) Steering Group Meeting #3

Date 10.00-12.00, 20th October 2017

Location Boardroom, Dargan Building, Heuston South Quarter, Dublin 8

Chair John G. Connaghan (JGC) Deputy Director General – Chief Operations Officer, HSE

Attendees

Steering Group Members

Eilish Hardiman (EH) Group CEO, CHG

Fionnuala Duffy (FD) Principal Officer, Acute Hospitals Policy, DOH

Greg Dempsey (GD) Assistant Secretary Finance, DOH

Jane Carolan (JCA) National Director of Health Business Services, HSE

John Pollock (JP) Project Director, NPHDB

Liam Woods (LW) National Director of Acute Hospitals, HSE – dial in

Muiris O’Connor (MO’C) Assistant Secretary R & D and Health Analytics, DOH

Rosarii Mannion (RM) National Director of Human Resources, HSE

Additional Attendees

Deirdre Faherty (DF) Office of the National Director, Acute Hospitals, HSE

Helen Byrne (HB) Assistant National Director, Acute Hospital Division, HSE

Róisín Mulqueen (RM) Programme / Project Manager, Acute Hospitals, HSE – dial in

Sadhbh O’Brien (SO’B) Integrated PMO for CHP&P Steering Group, HSE

Apologies

Áine Carroll (AC) National Director Clinical Strategy & Programmes, HSE

Joe Ryan (JR) Acting Head, Programme for Health Services Improvement, HSE

Stephen Mulvany (SM) Chief Financial Officer, HSE

Richard Corbridge (RC) Chief Information Officer, HSE

Tracey Conroy (TC) Assistant Secretary Acute Hospitals Policy, DOH

Key Discussion Points

1. Introduction

Agreed external assessment of governance of Steering Group, to be arranged by JR. Action

Agreed EH to liaise with JR regarding specification of this external assessment.

2. Minutes and Matters Arising

Agreed changes to minutes of previous Steering Group, proposed by MO’C and FD.

Agreed changes to format and introduction of action log, proposed by JGC and EH.

Discussed feedback on Heads of Bill. LW confirmed that the General Scheme text had been considered

by HSE Corporate and there was minimal feedback on the text provided to DOH.

3. Items Arising from CHP&P Board

a) EHR Programme:

JCA noted programme status red as key approvals (business case, funding and staff) are overdue.

MO’C noted challenges with all-encompassing, multi-annual business case and confirmed move to

modular approach; developing smaller business case, more specific to children’s hospital but part of a

national roll out.

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Discussed funding; limited funding available in 2018 but requirements are modest; requirements will

increase significantly from 2019 onwards.

Discussed cash flow over coming years; an exercise was done on this in April 2017 but probably needs

revision to be more modest; there will be more clarity on pricing when tenders are received.

Agreed MO’C and JCA to prepare (i) detailed timeline on plan for EHR business case and procurement

approval until March 2018 and (ii) overview of project management processes and governance for

discussion at the next meeting. Action

b) Managed Equipping Solutions:

GD confirmed next HTSS Steering Group meeting scheduled for 26th October 2017.

Agreed update on MES will be agenda item at next Steering Group. Agenda Item

Discussed MES Sourcing Strategy document, which proposes breaking MES business case in three lots.

EH confirmed Managed Lab Service (MLS) is not being pursued; included to demonstrate options.

Agreed need for engagement with DPER and NDFA for feedback on approach. Action

Agreed need for HSE support to cost traditional equipment compared to MES approach. Action

Agreed JCA to follow up with JP to discuss potential support from Elaine Maye. Action

c) Model of Care for Paediatrics Implementation Plan:

GT provided overview of MOC implementation plan.

- Identified 3 aspects of the MOC: acute services, healthy children, and community services.

- Confirmed fully costed, prioritised plan is due May 2018, in time for the estimates process.

- Noted this depends on internal and external resources being in place in 2017.

- Noted LW and AC engaging with JR in relation to these resources.

- MO’C noted he leads a Health Research Board, which may offer funding opportunities for relevant

medium-term work on the MOC implementation plan, which would warrant international awareness.

Discussed resource implications of MOC implementation, approx. €290m (staffing costs).

- Confirmed relevant resource implications were noted only in children’s hospital business case.

- Clarified any additional revenue funding required to build up a workforce for the new children’s hospital

and to implement the new MOC in the hospital would need to be considered as part of the annual

estimates discussions.

- Significant discussion about the reality of the annual funding mechanism that applies in the Irish health

system, and how it differs from experience abroad. Acknowledged implementing a capital project of this

scale without revenue funding agreed is a major risk.

- Agreed JGC and GD to have follow-up conversation relating to this concern.

Discussed governance of MOC implementation plan.

- Agreed MOC implementation plan will be standing agenda item in this forum. Agenda Item

- GT noted the Programme Sponsors, AC and LW, have agreed that the governance for the MOC implementation plan design is through the Service Delivery Board.

- Discussed potential for divergent decisions or duplication of work with two forums; need for clear remits.

- Agreed GT to prepare short paper on governance for CHP&P Board, with EH contributing. Action

d) Format for Reporting to CHP&P Board:

Agreed FD, SO’B and Siobhan Kennan to develop proposal to bring to JGC. Action

4. Update from NPHDB Capital Project

JP presented NPHDB reporting and capital cost update.

JP noted some emerging challenges, with estimated capital cost currently exceeding funding available.

JP noted this is a working estimate; it will be January-March 2018 before there is certainty.


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JP noted the figures presented take into account existing value engineering mitigation measures.

JP highlighted €20m allocated to additional fire safety; An Bord Pléanala decision on this is due

November 2017.

JP confirmed there will be reasonable certainty about the size of the funding deficit by end March 2018.

JP added that the agreed Guaranteed Maximum Price (GMP) will require Government / HSE approval by

early July 2018.

Discussed four possible options for addressing capital cost funding deficit including:

i) Descoping capital project: JP noted QS already exploring descoping options at a high level.

ii) Reallocating capital from wider HSE Capital Plan: JCA flagged difficulty due to contract constraints.

iii) Mitigating deficit through philanthropic funding: EH noted current commitment is to raise €20m.

iv) Engaging with DPER for additional funding.

Agreed EH to prepare a case on projected philanthropy funding by March 2018. Action

The use of funding raised by third parties warrants further discussion with DPER at a later date.

Agreed JP and EH to prepare short report for CHP&P Board that describes the emerging risks and

commits to looking at immediate ways to mitigate the deficit and, in parallel, exploring

backstop/contingency options in the event a sizeable deficit cannot be reasonably avoided. Action

5. Update from Children’s Hospital Programme

FD noted that timeline of March 2018 for legal enactment has been agreed with the Minister.

EH noted legal commencement date of 1st July 2018 has been supported by the executives and is being

recommended to the three Hospital Boards.

Discussion around other factors that will affect the actual commencement date. Need to ensure relevant

stakeholders are satisfied that any proposed commencement date is feasible, achievable and practical. In

this context, agreed EH to discuss commencement date with LW and SM. Action

EH noted three foundations have agreed to become a single philanthropic and fundraising foundation.

6. Standing Update on Children’s Hospital Programme Funding

Agreed EH to discuss funding with LW and SM. Action

EH noted funding does not match what was approved in the business case. All revenue requirements,

including for the integration programme, are considered as part of the annual estimates discussions.

EH noted likely resulting scenario for 2018 integration spend is that ICT implementation will be prioritised

over change management and clinical integration.

7. Standing Update on HR

RM confirmed priority posts for 2018 have been approved by HR to commence recruitment process,

which can take 12-18 months to recruit.

RM noted that workforce capacity in general is an issue.

EH confirmed proceeding with recruitment, with known risk that funding is not yet confirmed.

HB added that the posts are not reflected in 2018 estimates.

EH notes the priority posts have a total cost of €11m, with some in 2018 and most in 2019.

Agreed this is a critical risk, as the opening of the satellite centres depends on this recruitment.

Agreed EH to discuss with LW and SM as part of the wider conversation on funding.

RM noted good engagement with unions, but this will continue to be a challenge and a priority.

MO’C raised concern about overreliance on external ICT support.

Agreed EH to prepare proposal on ICT staffing to demonstrate internal-external balance. Action

Agreed RM to present on change management of change model at next Steering Group meeting. Action

8. Tallaght ICT Server Relocation

Raised concern about lack of clarity over who is leading on implementation, Tallaght or OoCIO in HSE.

Agreed JCA to clarify ownership of this activity directly with Tallaght Hospital. Action


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Action Log

Ref Action Owner Due

1 (i) Prepare detailed timeline on EHR until March 2018.

(ii) Prepare overview of PM processes and governance. MO’C / JCA 20/11/18

2

Convene HTSS Steering Group, including CHGB, and agree next

steps for completion of MES business case (business case due

February 2018; business case approvals due April 2018), including

meetings with NDFA & DPER to agree involvement, inputs, and

scope of programme.

GD 20/11/18

3 Confirm HSE resources and costings for traditional equipment

procurement for Public Sector Benchmark comparator. JCA 20/11/18

4 Discuss potential support from Elaine Maye for MES. JP / JCA 20/11/18

5 Paper on MOC implementation plan governance for CHP&P Board. GT / EH 20/11/18

6 Develop proposal for format of report to CHP&P Board. FD / SO’B 20/11/18

7 Estimate how much philanthropic funding could potentially generated

for the period until March 2018. EH 20/11/18

8 Paper on projected capital deficit for CHP&P Board. JP / EH 20/11/18

9 Follow up meeting in relation to commencement date, funding and

approval to recruit. EH / LW / SM 20/11/18

10 Proposal on ICT staffing to improve internal-external balance. EH 20/11/18

11 Update on change model at next Steering Group meeting. RM 20/11/18

12 Clarify ownership of Tallaght ICT server relocation. JCA 20/11/18

13 Proposal on external assessment of governance of Steering Group.

EH to contribute input into specification. JR 20/11/18


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Meeting Children’s Hospital Programme & Project (CHP&P) Steering Group Meeting #4

Date 10.00-11.30, 22nd

November 2017

Location Boardroom, Dargan Building, Heuston South Quarter, Dublin 8


Attendees



Eilish Hardiman (EH) Group CEO, Children’s Hospital Group (CHG)


Greg Dempsey (GD) Assistant Secretary Finance, DOH

John Pollock (JP) Project Director, National Paediatric Hospital Development Board (NPHDB)


Rosarii Mannion (RMA) National Director of Human Resources, HSE




John Smith (JS) Assistant National Director, Health Business Services (HBS), HSE

Róisín Mulqueen (RMU) Programme / Project Manager, Acute Hospitals, HSE – dial in


Apologies

Jane Carolan (JCA) National Director of Health Business Services (HBS) / Acting CIO, HSE

Joe Ryan (JR) Acting Head, Programme for Health Services Improvement (PHSI), HSE


Liam Woods (LW) National Director of Acute Hospitals, HSE


1. Minutes and Actions

Agreed changes to minutes from previous session; to circulate for approval with minutes for this session.

Discussed how funding for capital projects will be approved in future:

- JGC raised the issue of having separate processes for capital and revenue funding approvals.

- JGC queried if the DOH is aware of any intention in Government to change this approach.

- GD acknowledged it is a well-known problem that particularly impacts health.

- GD confirmed DOH has raised with DPER on numerous occasions.

- GD suggested could raise again if desired; agreed that this would be left to GD’s discretion.

- GD noted that business case approval for a capital project is a separate process from capital and revenue

funding approvals, and does require information on all associated costs.

- TC added for the national children’s hospital the DOH made a great effort to fully appraise Government on

future revenue implications during the decision on capital funding; information on Model of Care revenue

implications was not available at the time.

- JGC acknowledged this issue is beyond the scope of this forum alone and asked GD to give consideration

as to how to engage with Government on it.

Discussed governance of implementation of the Integrated Care Programme for Children: - Noted draft paper on this for CHP&P Board was received from Grace Turner and reviewed by JGC.

- AC explained the Integrated Care Programme for Children will report to the Service Delivery Board (SDB),

under PHSI governance; this is the most appropriate arrangement as it is mostly operational work.

- AC explained a significant amount of work is involved in the Integrated Care Programme for Children and

resource requirements have been identified but not allocated. AC is raising this internally in HSE. Action

- AC confirmed the programme is highly relevant to this forum and will remain a topic of discussion.

CREMINS

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PAC32-R-1939(v) B Meeting 14/02/2019


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- EH noted the governance arrangement is satisfactory provided it is clear where decisions are made, and

that interdependencies with the Children’s Hospital Programme continue to be discussed in this forum.

- TC asked that the final paper for CHP&P Board identifies a single person responsible for the programme.

- JGC proposed briefing all Steering Group members on the PHSI governance structure. Action

- JGC proposed briefing the Service Delivery Board to ensure it is fully aware of the interdependencies

between the Integrated Care Programme for Children and the Children’s Hospital Programme. AC agreed

to discuss with SM (Chair of Service Delivery Board). Action

Discussed reporting from CHP&P Steering Group to CHP&P Board: - Noted draft report format developed with input from JGC, SO’B, FD and Siobhan Kennan (DOH).

- Agreed to finalise and secure Secretary General approval before next CHP&P Board meeting. Action

Discussed progress on the proposed Commencement Date:

- EH confirmed CHG Board recommended the proposed commencement date, 1st July 2018, for approval

on the condition that certain criteria are met.

- EH noted a high-level preliminary report identifying potential issues with the proposed commencement

date (e.g. regulatory or fiduciary issues) is due for completion in December 2017. EH noted only one issue

has emerged so far – technical accounting standards relating to pensions. EH to raise with SM and LW.

- GD noted he is part of a DPER sub-group trying to resolve the same issue relating to pensions. Agreed

EH to arrange for Valerie Plant to circulate a paper to GD, JGC, LW and SM on the implications of this

issue for the entity on commencement. Action

- TC noted it is positive that the 3 hospitals support the proposed commencement date, indicating their

ability and willingness to be ready by 1st July 2018. TC clarified that the finalisation of the commencement

date depends on other factors; DOH need assurances for relevant stakeholders relating to all potential

issues, and need to complete an options appraisal comparing mid-year and start-of-year commencement

dates before making a recommendation on the final commencement date to the Minister.

- JGC queried how long an options appraisal would take. TC responded a matter of weeks.

- EH raised credibility challenges associated with moving from the proposed commencement date.

Discussed progress on approval to recruit roles with long lead times:

- EH noted cost of 2018 roles with long lead times have been revised down from €1m to €0.6m.

- EH worked with the Consultant Applications Advisory Committee (CAAC) on a proposal relating to this for

discussion at their December session.

- EH noted a letter of comfort regarding funding is required from the DOH and HSE for CAAC approval. EH

agreed to share a business case to support this to FD and LW this week. Action

- RMA noted the need for a proviso that funding will be available at point of offer.

Discussed concern raised by JP at last Steering Group meeting about relocation of Tallaght ICT server:

- SO’B noted JCA and PMO for the OoCIO confirmed this work is on track.

- JP flagged a potential disconnect between the project status being reported by OoCIO and Tallaght.

- JS agreed to follow up with JCA. Note: Following the Steering Group meeting, this matter was resolved by

JCA and JP; it was concluded that the project is indeed on track.

- Agreed further clarity required on ultimate responsibility for the server relocation. Note: Following the

Steering Group meeting, JCA confirmed this is David Wall, Director of ICT for Tallaght Hospital.

Discussed business case on ICT staffing:

- EH clarified definitive business case identified capital, consultancy support and future staff under ICT.

- EH noted CHP is looking to recruit future staff ahead of plan to reduce reliance on external support.

- MO’C noted an impression there is a heavy dependency on external consultants. EH confirmed the ICT

staffing paper being developed will give assurances that there is a balanced mix of resources.

- EH noted a challenge recruiting internal staff due to very competitive market and suggested the need to

go beyond recommended public sector pay rates. MO’C agreed to work with EH to make a case for this.

- Agreed the ICT staffing paper to be presented at the next Steering Group, 25th January 2018. EH and

MO’C to meet separately to review the paper in advance of this. Action


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- RMA advised recruiting over Christmas period has been an effective strategy for National HR and offered

resources to support early recruitment communications for the Children’s Hospital Programme during the

period. Action

2. Update on Electronic Healthcare Record (EHR)

MO’C noted a timeline for EHR has been developed and agreed to circulate. Action

MO’C reiterated that approval for EHR will no longer be sought as a single business case for c. €800m.

MO’C clarified the EHR vision is still national; the modular approach to the business case and tenders,

commencing with implementation in the new children’s hospital, is being used for practical purposes.

MO’C clarified the aspect of EHR most relevant to the new children’s hospital is Acute EHR, which relates

to all hospitals.

MO’C clarified the initial tender will be framed as a national roll out of Acute EHR, but will only be for

implementation in the new children’s hospital.

EH asked if there will be a separate tender for each individual hospital. EH raised a concern about this, as

the success of the new children’s hospital is dependent on the nationwide implementation of the Model of

Care, which requires all hospitals to have EHR to enable access to the same records.

JGC queried if this creates a problem in terms of value for money.

MO’C noted these details will be considered as part of the business case development.

EH suggested it would be beneficial to have a Children’s Hospital Group representative on the EHR

project. MO’C agreed to involve a Children’s Hospital Group representative in framing the business case

and tender. HB added it would be beneficial to have a MN-CMS representative. MO’C agreed in principle.

MO’C noted he will initiate preparatory discussions with the Office of Government CIO.

MO’C emphasised it is unknown whether the business case will get approval within timescales required.

Agreed separate meeting to discuss EHR before the CHP&P Board meeting. Action

3. Update on Managed Equipping Solution (MES)

GD noted some good progress establishing governance and Terms of Reference (TOR) for the

Equipment Procurement Strategy Board and Equipment Procurement Project Team; a key decision is that

its remit will now include considering the alternative procurement options and making a recommendation

for a preferred procurement methodology.

Agreed GD to set out update on MES progress in a paper. Action

JP raised a concern about the timeline for the MES business case. JP noted that he met with Elaine Maye

(EM) – HBS, previously involved in public-private partnership (PPP) – who presented a different view of

the scope of work involved in the business case and advised the current timeline for completing the

business case is unrealistic.

JP emphasised the need to engage DPER and the National Development Finance Agency (NDFA) to

understand what they want to see in the business case, to ensure it fully meets their needs.

GD noted that the first step is to get NDFA to commit to fulfil this role and NDFA advised they would

require the TOR in advance of this.

GD offered clarity about what DPER will want to see in the business case; DPER want the business case

done as if for PPP and will want to compare MES to traditional equipping and assess which offers better

value for money.

JP and EH raised a concern that DPER needs specific equipment requirements upfront as part of the

business case approval process, whereas they require flexibility until the competitive dialogue stage of

procurement, due to the interdependencies between EHR and equipment / health technology needs.

GD confirmed DPER will need relatively certainty about the list of equipment required; this is necessary in

any case for the Equipment Procurement Project Team to compare MES and traditional equipping.

JGC asked EH and JP to set out user requirements to establish common understanding of needs. Action

GD committed to reconvene the Equipment Procurement Strategy Board as soon as possible. Action

RMU referenced similarity to previous NAS experience and agreed to follow up on lessons learned. Action


V0.4 Page 4 of 5 [

4. Update on Funding

EH agreed to circulate business case on Director of Philanthropy this week. Action

JP confirmed An Bord Pleanála (ABP) decision – fire sprinklers must be fitted throughout the hospital.

JP noted that the independent expert and the inspector appointed by ABP ruled in favour of the NPHDB.

JP confirmed the decision has a cost implication of approx. €20m, making the current estimated gap

between total capital cost and funding available approx. €60m.

MO’C requested clarity on total cost of sprinklers, and the percentage increase in costs due to this

decision. Agreed this information can be included in the paper for the CHP&P Board.

JP explained he is working with EH to develop a back stop / contingency and will present a paper to the

CHP&P Board; JP and EH will brief JGC on this in advance of the CHP&P Board meeting. Action

JP noted this has identified capital items for descoping. GD noted that this potential mitigation is welcome.

5. Update on the Capital Build

JP raised risk around capital programme funding for 2018; €120m is being made available, which is €40m

lower than expected. JP noted this has been discussed with Jim Curran (JCU), HBS.

GD suggested this is due to different understandings of the initial commitment.

GD noted he understands the €120m is based on the contractual commitment.

JP noted that approx. €150m was set out in the definitive business case.

JP stated that JCA has acknowledged the 2018 programme funding gap.

Agreed for JCA, JCU, JP, GD and JS to meet and come to a resolution before year end. Action

6. Update on Proposal for External Governance Assessment

TC noted concern relating to scope of the assessment, as governance is mandated.

Deferred detailed discussion. Note: Since the Steering Group meeting JGC has clarified that his request

for a review of “Governance” applies only to the CHP&P Steering Group and is required to assure him that

the process of business carried out in the Steering Group is sound, and that information flows, decision

making and resources for project management satisfy appropriate business standards.

7. Update on Human Resources (HR)

RMA noted the revised Change Model was reviewed at the Enabling Board and further work is required.

RMA agreed a full update on the Change Model will be provided at the next Steering Group meeting.

EH proposed RMA meets with Phil Welsh, Director of Strategic HR, Organisational Development and

Change Management in the Children’s Hospital Group, in relation to union engagement. Action

EH noted a national workforce plan for children’s nursing in Ireland is underway and due to report April

2018 – this will provide an extensive analysis of demand and supply, and make recommendations.

EH noted there is a risk around recruitment of health and social care professionals.

8. AOB

Agreed to develop overarching critical path; EH and JP to brief JGC before CHP&P Board meeting. Action

Noted next Steering Group meeting is 25th January 2018. Agreed to extend future meetings to 2 hours.


V0.4 Page 5 of 5 [

Action Log


Carry Forward (amendments to actions made as appropriate)

1 Circulate EHR timeline to Steering Group members.

Prepare overview of PM processes and governance for EHR.*

MO’C /

JCA 01/12/17

2 Finalise paper on Model of Care governance for CHP&P Board. AC 01/12/17

3 Finalise format of report to CHP&P Board with Sec Gen approval.* FD / SO’B 01/12/17

4 Circulate business case on Director for Philanthropy. EH 24/11/17

5 Estimate potential philanthropic funding between now and March 2018.* EH 17/01/17

6 Finalise paper on projected capital deficit for CHP&P Board and brief JGC. JP / EH 08/12/17

7 Provide briefing on ICT staffing paper at next Steering Group.* EH 17/01/18

8 Provide update on change model at next Steering Group.* RM 17/01/18

9 Update on external assessment of governance at next Steering Group.* JGC / JR 17/01/18

New Actions

10 Update on resources for MoC implementation plan at next Steering Group. AC 25/01/18

11 Circulate paper on PHSI governance structure to Steering Group. JR 17/01/18

12

Ensure Service Delivery Board briefed on its governance of the Integrated

Care Programme for Children, and the interdependencies with the

Children’s Hospital Programme.

AC 01/12/17

13 Provide paper on impact of pensions issue for the entity on commencement. EH 08/12/17

14 Provide business case to support request for letter of comfort regarding

funding from DOH and HSE to support CAAC approval for recruitment. EH 24/11/17

15 Follow up on potential for Christmas communications campaign to generate

early momentum for new children’s hospital recruitment. EH / RMA 01/12/17

16 Follow up meeting in relation to EHR before CHP&P Board meeting. JCA / MOC 08/12/17

17 Prepare update paper on MES progress.* GD 08/12/17

18 Set out user requirements for MES.* EH / JP 08/12/17

19 Reconvene project board for MES as soon as possible. GD 22/12/17

20 Follow up on lessons learned from NAS relating to MES.* RMU 17/01/18

21 Follow up meeting on annual capital programme funding for 2018. JCA / JP 22/12/17

22 Follow up with Phil Welsh for insights on union engagement. RMA 22/12/17

23 Develop overarching critical path and brief JGC. EH / JP 08/12/17

* Please submit relevant pre-reading materials to SO’B by Tuesday, 17

th January 2018.

Children’s Hospital Programme & Project Steering Group

V1.0 Page 1 of 5 [

Meeting Children’s Hospital Programme & Project Steering Group Meeting #5

Date 15:00-17:00, 25th January 2018

Location Boardroom, Children’s Hospital Group, Herberton, Dublin 8


Attendees


John G. Connaghan (JGC), Deputy Director General - Chief Operations Officer, HSE



Eilísh Hardiman (EH) Group CEO, CHG






Paul de Freine (PD) Chief Architectural Adviser, HBS, HSE

Roisin Mulqueen (RM), Project Manager, Acute Hospitals, HSE

Noreen Noonan (NN), ICT Programme Manager, OoCIO, HSE

Frank O’Leary, Assistant National Director, Human Resources, HSE

Joe Ryan (JR) Programme Director Value Improvement Programme & GDPR, HSE

Fran Thompson (FT) Programme Director for Strategic e-Health Programme, HSE*


Apologies

Jane Carolan (JCA) National Director of Health Business Services (HBS) / Interim CIO, HSE


Colm Desmond (CD) Director of Finance, DOH




1. Minutes

JGC requested final feedback on minutes from previous sessions to be submitted by email to SO’B.

2. Actions

JGC raised Action 14 from Steering Group #4. TC and FD confirmed letter of comfort regarding funding to

support CAAC approval for recruitment is pending Ministerial sign-off and expected shortly without issue.

JGC raised Action 22 from Steering Group #4. EH confirmed this is ongoing. JGC proposed action closed.

SO’B confirmed all other actions are on track or being discussed during other agenda items.

3. Standing Update on Electronic Healthcare Record (EHR)

FT noted concerns regarding timelines for MedLIS and NIMIS.

FT noted emerging challenge with Tallaght Data Centre relocation; Tallaght Hospital concerned speed of

data restore function is insufficient. FT provided assurances this should not impact timelines.

JP requested OoCIO update timeline for Tallaght Data Centre relocation completion to June 2018. Action

FT noted minor delay in Definitive Business Case for Acute EHR, noting it should not impact timelines.

MO’C agreed to proceed to engage DPER. FT to reissue EHR revenue forecasts ahead of this. Action

EH queried if some Acute EHR approval steps can be done in parallel. MO’C agreed to raise with DPER.

FT presented document describing risks associated with EHR, highlighting lack of slack in timeline.

FT described significant risk of delay due to legal challenge once a preferred vendor is appointed.

FT confirmed an internal audit of the procurement process will be undertaken in anticipation of this.

CREMINS

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JGC requested visibility of how the audit will be done and updates at key points. Action

FT highlighted risk of delay due to negotiation process, based on experience with large vendors.

FT escalated need for EHR programme staffing; €757k requirement (50% clinical / 50% technical staff).

TC agreed to convene meeting with relevant stakeholders to discuss in detail and agree solution. Action

FT explained revenue costs of EHR were included in strategic business case for EHR but not funded.

FT noted DPER may seek assurances from DOH / HSE that revenue side of EHR is addressed.

JGC noted 3 aspects of revenue costs: people costs, ongoing running costs and double-running costs.

EH agreed to map combined revenue costs against available resources to identify gaps. Action

JGC noted there is some probability that the Acute EHR system maywill probably not be introduced ready

for introduction sufficiently in advance ofbefore the new children’s hospital building.

EH agreed to refresh contingency and backstop plans and bring summary view to Steering Group. Action

MO’C agreed to follow up on formation of DPER peer review panel for EHR approval process. Action

4. Standing Update on Equipping / Healthcare Technology

TC confirmed CD contacted NDFA. Agreed CD to provide clear timescale to confirm NDFA role. Action

JP presented paper on user requirements for MES, Competitive Dialogue and linkage with PPP.

JP presented paper summarising work completed to develop business case for Equipping / Healthcare

Technology.

JP noted NDFA is needed to work on risk transfer with NPH for the Business Case process.

Agreed need for further meeting with DOH on MES. Action

5. Standing Update on Capital Funding

JP noted backstop plan no.1 was rejected by all stakeholders and presented backstop plan no.2.

JP noted €20m additional funding will be sought from DOH for cost of additional fire sprinklers.

PD queried €2m saving from deferred procurement for ICU beds; HBS understanding was that original

budget did not allow equipment for these ICU beds, which will not be operational until further into future.

EH confirmed they were in original budget and decision will not impact number of ICU beds on opening.

PD raised concern that capital saving from MES is double counting. TC confirmed this is no longer an

option.

JP noted there will be a review with CHG to maximise how to drive value from existing assets.

EH confirmed this will be in conjunction with HBS Estates. See Action 29/3 from CHP&P Board.

JGC queried process for the €47m capital funding from commercial sources for the basement carpark.

JP confirmed, as set out in the Business Case, this requires HSE to cashflow the basement construction,

until NPH can raise commercial capital funding from carpark operators/funders on opening of the hospital.

All parties noted this is agreed in principle. Agreed to formalise with written agreement. Action

LW noted potential issue if timing spanned year end. PD added same concern for philanthropic funding.

LW clarified any discrepancy (surplus or shortfall) between the upfront capital funding of €47m provided

by the HSE and the money raised in the market will be borne by HSE, so there is a financial risk involved.

JP noted €13m shortfall in NPH capital funding for 2018. JGC noted same and asked for regular updates.

JGC queried process for capital funding from DES and HEA. FD confirmed meeting scheduled with DES

to discuss and update will be provided at next Steering Group. Action

PD raised emerging challenge around Ronald McDonald House Charity (RMHC) Family Accommodation.

RMHC initially planned to provide all capital funding. RMHC now propose to fund €8m upfront and ask

HSE to provide €7-7.5m lending for capital expenditure. PD explained it could take many years for this to

be repaid by RMHC.

Agreed SM and JCA to meet to agree HSE position on this unplanned capital requirement. Action

Agreed TC and CD to meet to clarify if using funding from HSE Capital Plan for this purpose would breach

the capital spending maximum agreed with DPER. Action

Agreed PD to prepare briefing paper on the issue prior to both meetings taking place. Action


V1.0 Page 3 of 5 [

6. Standing Update on Capital Project

JP noted that key items have already been discussed.

7. Standing Update on Integration

EH noted legislation timeline updated by DOH and released to CHP.

EH noted CHP&P Board agreed process for naming entity.

TC noted this process needs Ministerial approval, but no issues are anticipated.

8. Standing Update on Legislation

TC noted HSE observations received and responses issued.

JGC noted some further HSE observations due. Agreed strict deadline of end 26th January.

TC noted aiming to circulate next week.

9. Update on National Paediatric Model of Care

Discussion deferred. JGC noted focused session taking place on 29th January with key stakeholders.

10. Update on ICT Staffing

Discussion deferred. EH confirmed work is ongoing and update will be provided at next session.

11. Update on External Governance Assessment

JR confirmed desktop review and most stakeholder interviews are completed.

JR confirmed the assessment will be completed and presented at February / March Steering Group.

EH raises concern regarding ICT / EHR governance. JR noted this will be considered as part of separate

work with SO’B to look at key interdependencies.


FO’L confirmed work has concluded on the revised Change Model.

FO’L confirmed the framework for recruitment and retention has gone to HSE Leadership for review.

13. AOB

EH noted lessons learned report from Australia site visits. Agreed as agenda item for next meeting. Action

Action Log

Arising from CHP&P Steering Group


Carry Forward

1 Prepare overview of PM processes and governance for EHR. JCA 15/02/18

2 Provide update on change model at next Steering Group.* RMA 15/02/18

3 Confirm resources secured for MoC implementation plan. AC 09/02/18

4 Confirm letter received from DOH to support CAAC approval for recruitment. EH 09/02/18

New Actions

5 Update timeline for Tallaght Data Centre relocation to reflect June end date. FT 09/02/18

6 Proceed with further engagement with DPER regarding Acute EHR. FT to reissue

EHR revenue forecasts to provide a basis for these discussions. MO’C 15/02/18

7 Provide paper for next Steering Group describing how the internal procurement

process audit for EHR will be done.* FT 15/02/18

8

Convene meeting with stakeholders (DOH; HSE - OoCIO, Acutes; CHP - ICT,

Chief Clinical Information Officer) to discuss resource requirements for EHR

programme and agree solution.

TC 15/02/18

9 Provide paper for next Steering Group mapping elements of Acute EHR revenue

costs year-on-year against available resources to identify gaps.* EH 15/02/18


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10 Present refreshed contingency plan and backstop plan for Acute EHR at next

Steering Group.* EH 15/02/18

11 Provide progress update on formation of DPER peer review panels. MO’C 15/02/18

12 Provide definitive timescale to confirm NDFA role.* CD 15/02/18

13 Convene meeting between DOH & HSE on Equipping / Healthcare Technology. CD 09/02/18

14 Prepare written agreement between HSE (HBS Estates and Finance) and NPH

building board regarding arrangements for cashflow for construction of carpark.*

JP /

JCA 15/02/18

15 Provide update at next Steering Group regarding process for capital funding from

DES and HEA. FD 26/02/18

16 Prepare briefing paper on emerging issue regarding funding for Ronald McDonald

Family Accommodation, to inform meetings on same. PD 09/02/18

17 Agree HSE position on Ronald McDonald Family Accommodation proposal. SM /

JCA 15/02/18

18

Provide clarification if the use of funding from the HSE Capital Plan to cover

unforeseen capital expenditure for Ronald McDonald Family Accommodation

would breach the agreed DPER capital spending maximum.

TC /

CD 23/02/18

19 Present lessons learned from Australia site visits at next Steering Group. EH 26/02/18

*Pre-reading materials for next Steering Group meeting (26

th February) due before 12pm on 16

th February.

Arising from CHP&P Board


Action

10/2

EH to look at the feasibility of both establishing the new entity on a statutory basis and transferring to the new entity the three hospitals at the same time and establishing the new entity on a statutory basis in advance of the transfer to the new entity of the three hospitals and submit to DoH.

EH March

Action 11/2

EH to circulate a formal business case for a Director of Philanthropy to CHP&P Steering Group for consideration by the Steering Group prior to submission by JC to DoH.

EH March

Action 15/2

JC to submit a full brief for Board meeting No 4. (capital shortfall) JC March

Action 18/2

JC to report to the Board on progress made on the proposed governance structures at Board meeting No 4. (Model of Care)

JC March

Action 23/3

Subject to approval by Minister, EH and Secretariat to progress arrangements for the naming process

EH / SK TBC

Action 24/3

Legislation update - Secretariat to address any outstanding issues with the CHG and with the OPC.

SK ASAP

Action 25/3

DoH to bring clarity to the role of the NDFA to enable JP to conclude the MES business case within required timeframe.

CD ASAP

Action 27/3

NPHDB Board to note that the €20m in contingency funds is to be assigned to known cost increases as identified by the CHP&P Board (ref action 13/2) (JP).

JP ASAP

Action 28/3

JP to submit business case to DoH for €20m for sprinklers as an out of scope additional project cost (Ref action 12/2). Due prior to CHP&P Board meeting on 14

th March so it can be considered.

JP March

Action 29/3

Alternative funding contribution options to be explored further including philanthropy, options on securing existing funds of the three children’s hospitals’ Foundations for this project; initiate/continue review of existing children’s hospitals’ assets and how to drive best value from them, including a value and disposal strategy for OLCHC and possible use of Temple Street (EH and HSE) - to be brought to the CHP&P Steering Group. Due prior to CHP&P Board meeting on 14

th March so it can be considered.

EH / JCA March


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Date 15:30-17:30, 26th February 2018

Location Green Room, Dr. Steevens’ Hospital, Dublin 8


Attendees











Jim Curran (JCU) Head of Estates, HBS, HSE


Mags Giffney (MG) Integrated PMO for CHP&P Steering Group (CHP&P SG), HSE

Noreen Noonan (NN), ICT Programme Manager, OoCIO, HSE

Sadhbh O’Brien (SO’B) Integrated PMO for CHP&P Steering Group (CHP&P SG), HSE

Frank O’Leary, Assistant National Director, Human Resources, HSE


Fran Thompson (FT) Programme Director for Strategic e-Health Programme, HSE

Apologies





1. Minutes & Actions

• JGC noted no feedback on minutes from previous meetings. JGC confirmed these are approved.

• JGC asked that feedback on minutes is submitted promptly by email following meeting.

2. Lessons Learned Review of Australia Site Visits

• EH presented lessons learned from CHG team’s Australian Hospital Tour – see pre-reading presentation.

• EH noted Lady Cilento is closest comparison; it will have an integrated hospital and community network.

• EH noted previous CEO of Lady Cilento is on CHG Board, supporting strong knowledge exchange.

• EH concluded key risks are interdependency on ICT and the complex change management, integration

and people issues.

• MO’C queried NPH construction costs and how they compare to international best practice.

• JP and EH confirm cost per square metre is more accurate metric than price per bed and is relatively low.

• TC confirms benchmarking of construction costs was reviewed in detail as part of DBC approval process.

3. Standing Update on EHR

• TC confirmed €760k ICT revenue funding shortfall for 2018 was resolved at pre-meeting. TC confirmed

this was done without placing additional strain on national HSE services, in response to query by SM.

CREMINS

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• Discussed delay in Acute EHR business case:

- FT confirmed 3-4 week delay due to issues with quality of work by Deloitte.

- JGC agreed to escalate with letter of concern to Deloitte. FT to draft. Action

- EH requested updated week-by-week plan to September 2018, reflecting new timeline. Action

- MO’C noted feedback from DPER that approvals process (presented by FT in Steering Group #5) does

not need to be strictly sequential, as previously understood; this could mitigate some delay.

• Discussed meeting between DPER, DoH and OoCIO on 15th February 2018:

- FT and MO’C noted overall the meeting was positive.

- FT noted DPER gave early indication of risks, some of which go beyond ICT risk.

- EH noted some risks that arose relate specifically to the integration and operation of the new children’s

hospital, as well as, Acute EHR rollout, and as such requested a CHG or Acute Hospitals representative is

part of this team going forward.

- MO’C noted work is underway with Government CIO Barry Lowry to map out approval process in detail.

• Discussed governance of National EHR programme, which includes Acute EHR programme: - FT and MO’C noted DPER emphasised importance of EHR governance arrangements.

- FT noted the current TOR for the EHR Steering Group was issued to SO’B last week.

- FT noted the EHR governance is currently being revised and strengthened, following meeting with DPER.

For discussion at next CHP&P Steering Group meeting. Action

- JGC noted EHR programme has transitioned to new phase and a review of governance is timely.

- EH agreed to feed into this process for CHG as business owner of first roll out of Acute EHR project.

- TC requested update prior to meeting with DPER on draft Children’s Health Ireland Bill on 1st March.

• EH presented on ICT resources for the CHP including existing, ICT programme and future resources. –

see pre-reading presentation. SM enquired if comparability undertaken of future resources against

requirements for a Digital Hospital. HSE reviewed this with Gartner (IT Advisors) as part of the Definitive

Business Case review.

-

- EH confirmed the 50:50 internal-external resource mix as set out in DBC is being achieved.

- MO’C asked EH for further detail on the conceptual transition plan (outlined on pg. 5) and further detail on

balance of internal-external resources in terms of cost. Specific meeting on this to be arranged. Action

- EH noted challenge attracting qualified ICT resources – public service not competitive with IT market.

• Discussed Acute EHR contingency and backstop plans.

- EH agreed to update to contingency plan to reflect current timelines. Action

- JGC requested combined paper on contingency and backstop plans.

- EH suggested backstop plan no longer viable as project has advanced to point where it is no longer valid.

- Agreed to detailed discussion at next CHP&P Steering Group meeting. Action


• CD confirmed NDFA was engaged in early February 2018; initial response received last week.

• CD agreed to convene Equipment Procurement Strategy Board next week to discuss further. Action

• EH noted work on risk evaluation and transfer progressing and would benefit from NDFA input.

• CD noted contingency plan is to procure an alternative advisor, in response to query by JGC.

• JP explained NDFA are the preferred advisor as DPER is familiar with and trust their approach and an

alternative advisor may cause delays due to duration of procurement and because DPER would be

unfamiliar with their approach; there will also be a cost impact of external procurement.

• JP confirmed draft MES business case for imaging will be issued to progress discussion. Action

• JGC suggested query into DPER may help. SM suggested also asking DPER next preferred advisor.


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• JP outlined Sprinkler Funding Business Case – see pre-reading paper. FD noted comments for follow up.

• SM queried progress on value engineering target. JP confirmed target is €62m and is currently on track.

• JP confirmed capital budget overrun currently projected at €35m (after €20m additional funding for

sprinklers, €6m additional savings relating to equipment, and before use of €20m contingency reserve).

• EH noted discussions about alternative funding sources underway. JGC requested paper by April, to

resolve before Memo to Government in May 2018. JGC requested update for noting for CHP&P Board

meeting on 14th March. Action

• Discussed funding arrangements for car park:

- JCU explained HSE will cashflow €47m for its construction, with money to be returned for 2022.

- JCU confirmed €47m is allowed for in the HSE capital plan, as part of annual allocation to NPHDB.

- JCU explained funding for repayment will be raised in market by leasing rights to cark park yields.

- JCU confirmed any gap between €47m and what is raised in market is borne by the HSE.

- SM queried if €47m is allocated to general spending or new children’s hospital once repaid; JCU

responded that this is not specified.

- SM noted payment of €47m in a single instalment will be a challenging term in a commercial agreement.

- JGC queried the likelihood of having a commercial agreement signed prior to 2022 and noted risk.

- JCU agreed to respond to letter from JP on this matter, being explicit about the nature of the agreement,

who bears the risk, and how the €47m is provided for in the HSE capital plan. Action

- EH agreed to circulate existing briefing paper on Q&A relating to car park funding arrangements. Action

• Discussed other funding arrangements:

- JCU noted similar arrangements exist in relation to DES / HEA and philanthropic funding.

- EH noted €20m philanthropic funding allocated to the build.

- JCU noted €5m philanthropic funding needs to materialise by 2021 to cover capital spending.

- SM queried if there are parts of the build associated with the €20m philanthropic funding that can be

deferred or descoped if the funding does not materialise; JP agreed to revert. Action

- TC noted need to bottom out appropriate arrangements prior to Memo to Government in May 2018.

• Discussed funding for Ronald McDonald House Charity (RMHC) Family Accommodation:

- JCU confirmed HSE currently own site and would also own asset from opening, and lease to RMHC.

- JCU confirmed the gap is approx. €7m and there is no allocation for this in the HSE capital plan.

- JCU noted no contract currently in place, but construction would ideally take place between 2020-2022.

- SM suggested possibility other organisations could provide funding, due to nature of the project.


• JP shared drone footage of progress on construction sites. Advancement of the capital build welcomed.

7. Standing Update on National Paediatric Model of Care

• AC noted revised PID to go to HSE Leadership by end of this week. Action

• AC noted decision on project resources due by end this week. Action

• EH noted the elements of MoC critical for new children’s hospital (i.e. Phase 1) are now agreed. Action

• TC noted importance of clarity around MoC implementation plan for Memo to Government in May 2018.

• JGC proposed, accordingly, that the MoC implementation plan needs to be complete by end April 2018.

• JGC noted the MoC implementation plan will go to HSE Leadership for approval; if timing does not permit

prior discussion at a CHP&P Steering Group meeting, it will be circulated to members for consideration.

• SO’B queried if capital and equipment requirements need to be considered for Memo to Government.

• AC noted these are out of scope of the MoC implementation plan, which is restricted to resources.

• TC and FD agreed to consider offline in conjunction with DOH Capital Unit in context of national paediatric

capital requirements to facilitate MOC implementation. as part of

• JGC requested weekly progress update on MoC is circulated to CHP&P Steering Group. Action


V1.0 Page 4 of 4 [


• TC confirmed any outstanding issues with OPC regarding legislation expected to be resolved this week.

• EH noted any further delay will impact on Connolly OPD & UCC opening date.

• EH confirmed urgent posts approved by CAAC and acknowledged work from colleagues in this regard.

9. Update on ICT Staffing

• Discussed under 2. Standing Update on EHR.


• JGC agreed discussion deferred until next CHP&P Steering Group meeting.

11. Update on Governance Review

• JGC noted as priority item for discussion at next CHP&P Steering Group meeting.

12. AOB

• JGC asked for feedback on frequency of CHP&P Steering Group meetings.

• General agreement monthly CHP&P Steering Group meetings are appropriately frequent.

• General agreement that more frequent and targeted sub-meetings would be beneficial.

• JGC agreed with this proposal, provided key decisions and actions arising are communicated to and

managed through the CHP&P Steering Group.


V4.0 Page 1 of 5 [


Date 15:30-17:30, 26th March 2018

Location Boardroom, Children’s Hospital Group, Herberton, Dublin 8


Attendees


Áine Carroll (AC) National Director Clinical Strategy & Programmes, HSE – dial-in

Tracey Conroy (TC) Assistant Secretary Acute Hospitals Policy, Department of Health (DOH)



Eilísh Hardiman (EH) Group CEO, Children’s Hospital Group (CHG)



John Pollock (JP) Project Director, National Paediatric Hospital (NPH) Development Board



Jim Curran (JCU) Head of Estates, HBS, HSE

Paul de Freine (PD) Chief Architectural Adviser, HBS, HSE

Sadhbh O’Brien (SO’B) Integrated PMO for CHP&P Steering Group (CHP&P SG), HSE



Apologies





1. Minutes & Actions

JGC noted feedback on minutes received from FD and confirmed approved.

2. Update on Governance Review

JGC noted purpose was to seek best practice advice regarding how we operate as a forum.

JGC noted governance of the CHP&P Board, CHG Board and NPH Board were out of scope.

JR presented overview; general agreement on value of exercise and key recommendations.

Discussed recommendation for interim mechanisms for communication between CHP&P Steering Group

and current hospital boards. EH and TC noted engagement is currently between CHG Board and hospital

executives, and this is effective. Agreed JR to update language in final version of governance review.

Discussed sensitivity of information shared at CHP&P Steering Group, and the importance of document

confidentiality and control. Acknowledged there has been no issue to date regarding information security,

but agreed it is an important risk. Agreed JR to reflect in final version of governance review.

Discussed need for additional members of CHP&P Steering Group. Agreed proposed CHO representative

should have broader remit, i.e. community, social inclusion and disability. EH and AC proposed Anne

O’Connor, National Director for Community Operations, HSE as the appropriate representative.

TC noted governance arrangements of CHP&P Steering Group were approved by government and the

Secretary General should be appraised of proposed changes to membership. JGC acknowledged same,

noting approval for additional membership will be sought from CHP&P Board. Action

Discussed recommendation regarding memoranda of understanding and clarified these are intended

between the CHP and divisions of the HSE where critical dependencies exist. JR noted this practice has

worked well previously for Tusla. Agreed JR to clarify in final version of governance review.

Agreed JR to prepare final version, which JGC will present to CHP&P Board for information. Action

CREMINS

Typewritten Text

PAC32-R-1939(viii) B Meeting 14/02/2019


V4.0 Page 2 of 5 [

Agreed JR and SO’B to proceed with implementing selected straightforward and high priority

recommendations, as identified by JGC, drawing on Steering Group members for input as required.

Agreed governance review will be an agenda item in CHP&P Steering Group meeting in May 2018, to

track progress of implementation of recommendations.

3. Standing Update on EHR

National EHR Governance

FT presented updated EHR governance, which is due for review by HSE Leadership on 29th March 2018.

All relevant stakeholders present agreed general satisfaction with strengthened EHR governance.

MO’C noted the proposed governance was shared with DPER in draft for information.

FT agreed to remove term “co-chair” in draft presented at HSE Leadership meeting on 29th March 2018.

EH asked for work to be undertaken by the CHP to clarify how issues arising from the CHP are escalated

to EHR Steering Group and CHP&P Steering Group, developing a RACI matrix for different scenarios. JR

agreed to support. Action

National Acute EHR Approval

FT confirmed final National Acute EHR business case is complete and approved by EHR Steering Group,

subject to conditions raised by CHG members.

MO’C confirmed he will review final version and share with DPER.

FT noted work has started developing statement of requirements (SOR) and procurement documentation.

FT noted progress in relation to the formation of the DPER peer review panel has been limited.

Medical Devices Integration

FT raised issue around medical devices integration. This was never part of the National EHR proposal but

is required for a HIMSS level 6 hospital. The cost is not included in the National Acute EHR business case

(inclusion being sought by CHG) or the CHG ICT business case.

FT explained this will create an additional cost, but it can be minimised if procurement of new medical

devices stipulates they are IHE compliant. FT noted, however, potential complexity and cost involved if

legacy medical devices are not IHE compliant.

JGC noted any additional cost arising from this challenge was not included in the definitive business case

approved by DPER, and exceeding the prescribed budget is problematic. JGC asked for clarity about the

financial risk associated with this challenge and a resolution prior to memo to government.

AC agreed to consider this issue in more detail at the next EHR Steering Group meeting on 19th April

2018. AC to decide what work is required prior to this meeting to enable a successful resolution. Action

CHG Acute EHR Contingency Plan

EH agreed to update CHG Acute EHR contingency plan. Action

4. Standing Update on National Paediatric Model of Care (MoC)

AC agreed to circulate 1-page update submitted to CHP&P Board to Steering Group members. Action

JGC confirmed work will now focus on elements of the MoC critical to the new children’s hospital.

HB confirmed Dean Sullivan, Deputy Director General Strategy and Planning, HSE, is now leading the

MoC governance and has asked her to become involved.

HB noted need to clarify interdependencies with Women and Infants Programme.

HB noted MoC work will consider what needs to be implemented in short, medium and long-term.

EH confirmed site visits are scheduled with key regional paediatric units to identify local requirements for

the implementation of the model of care.

TC noted the Memo to Government will provide an opportunity to update Government on the progress on

MOC implementation and associated costings AC agreed and confirmed on track for costings to be

complete by end April 2018 to align with this timeline.

TC asked for clarification about how capital implications of implementing the MoC in the regional and local

paediatric services will be considered.


V4.0 Page 3 of 5 [

AC confirmed they are out of scope of the MoC costings, except for transport / retrieval.

PDF asked to what extent are capital requirements already captured by individual capital plans.

HB provided anecdotal evidence, noting different locations have considered them to varying degrees.

Agreed need to demonstrate that hospital capital plans are aligned to the capital requirements to facilitate

the implementation of those elements of the MoC critical to the new children’s hospital, so that this can be

reflected in the memo to government. Action


EH confirmed implementation of Clinical Directorate structure is being progressed. EH confirmed cross

hospital CDs will be executively accountable for quality care, access, people and finances. EH confirmed

CDs will report to her directly.

EH provided update on central referrals pilot – on track for general paediatrics to start using single PAS by

October 2018, with an office in Temple Street to redistribute central referrals. There is a data governance

issue because the three locations will not be part of a single entity by this point. JR agreed to follow up

with EH to provide lessons learned from similar example. Action

EH noted IR issue arising as Tallaght payroll moves to national shared services. EH explained Fórsa are

trying to engage with CHG on this as a local issue, but it is part of a national rollout, so CHG is liaising

with RM and directing queries to national HR.

EH raised challenge around MedLIS – the rollout has been re-planned and CHG sites are no longer in

Phase 1. EH sought clarity about when Phase 2 will be scheduled. Action

6. Standing Update on Pre-CAR and Action Plan

EH noted the Pre-CAR report will be completed by end March 2018 and a detailed action plan will follow

in April 2018, outlining steps to address issues or risks identified, accountable owners, and deadlines.

EH confirmed both the Pre-CAR report and detailed action plan will be submitted to CHP&P Board.

EH asked that Pre-CAR and progress against the action plan remains a standing item at this forum, in line

with request from CHP&P Board.


Sprinklers Funding Business Case:

JP noted TC and FD are satisfied with business case for sprinklers funding and will proceed to seek

funding approval.

Capital Backstop Plan:

JP presented capital backstop plan no.3. JP explained the current estimated budget shortfall is €35m -

€20m to be offset by NPH contingency, on instruction from CHP&P Board, against advice from JP; €9m to

be offset by once-off funds raised from dissolution of existing hospital foundations; €6m to be offset by

philanthropic funding.

JP explained the intention, as discussed at CHP&P Board, in assigning the NPH contingency to known

costs at such an early stage in the capital project is for it to be re-filled as other funding sources are

received. JP noted this involves significant risk as some funding sources may fall short of expectations

and the holder of this risk would need to be confirmed.

JGC flagged considerable risk associated with relying on philanthropic funding, particularly when it is due

towards the late stages of the capital project.

EH confirmed philanthropy business case is on track for completion in April. It will cover governance and

management arrangements for philanthropic funding and will estimate how much will be raised and by

when.

TC emphasised need for the philanthropy business case to be comprehensive, to support the memo to

government.

Phasing of Capital Allocation:

JP referred to letter and table submitted by Jim Curran, outlining the timing of capital funding.


V4.0 Page 4 of 5 [

JP flagged this does not align with NPH cashflow as set out in the Business Case and will not align with

current projected cashflow being prepared by NPH.

JP noted potential shortfalls of €60m in 2019 and €50m in 2020.

JGC asked if the expected gaps could change. JP confirmed they may decrease or potentially increase,

depending on GMP agreement with the contractors.

JP agreed to prepare a briefing paper on the current anticipated cashflow gap by year. PDF requested

involvement in this. JP agreed to review the paper with NPH Board next week and share with Jim Curran

and relevant Steering Group members following this. CD and TC agreed to meet to review the paper on

receipt. Action

Car Park Funding:

JP noted NPH and CHG just completed a 1-week survey in Crumlin hospital of visitor and parent car

parking demand; this will be used to further develop and validate the revenue model.

JP noted the Minister for Health ordered a national review of hospital car parking charges on 16th March,

to be carried out by John Hennessy, National Director Acute Strategy & Planning, HSE.

JGC noted he has requested SM review the car park business case but will put this on hold until after

John Hennessy has completed the review. Action

EH to brief John Hennessy on the issue of car parking charges in relation to the new children’s hospital

and facilitate an introduction with JP. Action

Ronald McDonald House Charity (RMHC) Funding:

PDF confirmed the draft legal agreements relating to RMHC Family Accommodation will be issued and

discussed with stakeholders in the near future.

SO’B queried if an explicit decision has been made about whether the HSE will provide funding to RMHC.

Note: no decision recorded at CHP&P Steering Group – see minutes from 26th

February 2018.

JGC queried who is intended to sign the legal agreements. PDF confirms HSE and RMHC.

JP queried who holds the risk of a shortfall in capital funding for the project. JGC recommends SM’s paper

on financial risk will provide clarity. Note: SM’s paper identifies NPH as the ultimate risk owner.

Agreed SM to finalise paper on financial risk associated with the new children’s hospital and issue to CD

for consideration. Action

Education Funding:

FD confirmed work is underway for a decision ahead of the memo to government.

FD confirmed the QS in DoE / HEA understands the rationale for the pro rata costs as presented by NPH.

FD explained DoH will seek funding from DoE / HEA to cover actual pro rata costs, while noting the

definitive business case for the new children’s hospital only assumed receipt of a portion of these costs.

Guaranteed Maximum Price (GMP) Approval

JP confirmed end June 2018 as current expected timeline for GMP agreement with contractor (original

target May 2018).

JP noted GMP agreements with main contractor are currently unsatisfactory and this issue has been

escalated.

TC noted the timeline for the memo to government is dependent on readiness of GMP agreement. If GMP

approval slips further, there is a risk the memo to government could be delayed until after government

summer recess, which would likely have implications for the overall new children’s hospital timelines.


JP confirmed construction is progressing well across all 3 sites.


CD confirmed work is continuing to secure a meeting with NDFA in early April 2018.

CD noted DPER have been consulted informally and indicated support for NDFA involvement.


V4.0 Page 5 of 5 [

JGC noted deadline for approval of the MES imaging business case is April 2018 and asked if there is an

alternative option if NDFA engagement is not viable. CD confirmed that the Equipping Board has not

considered who else it would approach.

JP noted if the approval of the MES imaging business case goes beyond a certain point, there will no

longer be sufficient time for MES procurement, and a decision will need to be made to revert to traditional

equipping. JGC asked for clarity about when this point is. Action


RM noted an increase in IR activity is expected, and national HR and CHG will need to work closely.

11. AOB

JGC emphasised the need for full attendance by CHP&P Steering Group members, given the importance

and scale of the project, and the stage at which it is. JGC called for all CHP&P Steering Group members

to prioritise attendance of CHP&P Steering Group meetings.

JGC suggested, given the scale and important of the project, someone should be assigned to document it

as a case study. EH and RM noted ideas already exploring this option.

JGC noted need for an integrated critical path setting out key activities, dependencies and timelines.

Agreed JR and SO’B to develop this with input from relevant stakeholders for CHP&P Steering Group

meeting in May. Action


V1.0 Page 1 of 5 [


Date 15:30-17:30, 23rd

April 2018

Location HSE, PHSI Programme Room, Parkgate Street, Dublin 8


Attendees


John G. Connaghan (JGC), Deputy Director General - Chief Operations Officer, HSE

Tracey Conroy (TCO) Assistant Secretary Acute Hospitals Policy, DOH

Martin Curley, (MC) Chief Information Officer, HSE










Tim Carey (TCA) Assistant National Director, Clinical Strategy & Programmes, HSE

Margaret Giffney (MG) Integrated PMO for CHP&P Steering Group, HSE

Frank O’Leary (FO’L) Assistant National Director, Human Resources, HSE




John Smith (JS) Assistant National Director, Health Business Services (HBS), HSE

Apologies

Jane Carolan (JCA) National Director of Health Business Services (HBS), HSE





JGC confirmed minutes from CHP&P Steering Group in March approved.

Discussed CHP&P Steering Group governance review, presented at CHP&P Steering Group in March:

JR noted the scope of the governance review was limited to the CHP&P Steering Group, not the CHG or

NPH Boards.

JR circulated key recommendations for immediate action. JGC asked JR to assign owners to key

recommendations and proceed to implement. Action

EH noted it was previously agreed the additional CHO representative would have a wider remit of national

community services – agreed JR to update in CHP&P governance review accordingly.

Agreed additional Health & Wellbeing representative is not required immediately – to be explored later.

TCO flagged concern about attendance of CHP&P Steering Group members.

JGC noted he will raise any proposed changes to CHP&P Steering Group membership with Jim Breslin,

Secretary General of the DoH, in his capacity as Chair of the CHP&P Board.

2. Standing update on Integration

EH presented the integration paper submitted – progress is proceeding with no exceptions.

EH explained the integration paper submitted is organised by the releases that the Children’s Hospital

Programme PMO is using to structure its work: Commencement, Central Referrals Pilot, Connolly

Outpatient and Urgent Care Centre (OPDUCC), Tallaght OPDUCC, New Children’s Hospital.

CREMINS

Typewritten Text

PAC32-R-1939(ix) B Meeting 14/02/2019


V1.0 Page 2 of 5 [

EH confirmed the integration paper submitted aligns with the work breakdown structure outlined in the

Children’s Hospital Investment Case (20th February 2017). However, the paper submitted focuses only on

the most immediate and urgent elements of work.

TCO noted circulation of draft Bill to government is imminent. TCO explained discussion about a phased

commencement is underway. TCO confirmed this will be concluded before next CHP&P Steering Group.

JGC asked when the new model of clinical directorship will be in place. EH confirmed next year and noted

the single entity would need to be established to enable it. EH noted plans allow for a shadow period.

EH described risks outlined in Children’s Hospital Programme report. In particular, EH flagged that getting

hospital resources backfilled and released by hospitals is taking longer than planned. JGC asked about

mitigation strategies. EH noted possibility of exploring external resources for a limited period of time.

EH described issues outlined in Children’s Hospital Programme report. In particular, EH flagged challenge

of getting hospitals to prioritise ICT requirements for Connolly OPDUCC over existing individual hospital

ICT plans – CHG and OoCIO are actively engaging with hospitals in this regard.

3. Standing Update on Pre-CAR

EH confirmed the Pre-CAR report was brought to CHG Board and updated following feedback. EH agreed

to formally issue to selected CHP&P Steering Group members. Action

EH explained the recommendations of the Pre-CAR report are being addressed by a Pre-CAR action

plan, already circulated to selected CHP&P Steering Group members. EH confirmed there are currently

no escalations to the CHP&P Steering Group– all actions are being progressed.


FO’L confirmed no HR items for escalation at this point.

EH explained unions have agreed in principle for consultants in new posts in the OPDUCCs to work

outside 8am-8pm and expect to be engaged on remuneration. EH noted this is a national issue so CHG

have escalated to National HR via RM.

EH noted CHG require clarity about remuneration before first consultant contracts are signed in Q4 2018.

LW noted renegotiation of consultant contract, if required, would have universal applicability and would be

considerable work.

EH noted the possibility of ring-fenced resolution for paediatric consultants is being considered.

JGC requested short paper from FO’L on this item describing implications. Action

EH noted she has escalated to RM the need for smoother CAAC process going forward.

EH noted she has escalated to RM the need for engagement with the unions at a national level on the roll-

out of a national Pay and Staff Records system in the CHG.

JS queried if change in commencement date impacts payroll go-live for 200 staff in Tallaght in January

2019. EH confirmed the go-live date stands.

CHG seeking HSE HR engagement & national direction on HSCPs executive leadership arrangement.


Guaranteed Maximum Price (GMP) Approval

JP noted GMP approval by end June is significantly at risk.

JP flagged pricing discrepancies between NPH quantity surveyors and BAM/M&E Contractors.

JP explained that pricing discrepancies that cannot be agreed will go to the agreed independent expert to

adjudicate, which will take time.

JP confirmed that BAM agree that the overall programme completion date is still achievable, provided

some critical path activities in Phase B contract are brought into Phase A contract to continue work on site

without delays.

TCO recognised need to invest time in concluding the process of GMP approval to ensure best value for

money, however raised concern about the potential impact on the overall programme completion date.

TCO asked at what point would slippage in GMP approval impact on the overall completion date. JP

explained this is difficult to assess without an integrated programme being agreed with BAM/M&E

Contractors, but tentatively suggested autumn this year.


V1.0 Page 3 of 5 [

JGC asked about the financial risk involved. JP explained it is too early to estimate at this point. JP

agreed to provide clarity about the timeline and financial risk by June. Action

TCO noted the slippage in the GMP approval will delay the memo for Phase B construction decision to

government and suggested the possibility of an interim memo for information to government in summer to

provide an update on overall progress.

Integrated Critical Path

JGC asked for progress update on an integrated critical path for the new children’s hospital 2022.

JR and SO’B confirmed work is ongoing and it will be completed by mid-May, in advance of the next

CHP&P Board meeting.

JR and EH agreed ultimate ownership of the integrated critical path is with the CHG programme director.

Contractor Pay Entitlements

JP explained that the contractor has made a claim following Government enactment of a Sectoral

Employment Order (SEO) to increase construction industry minimum pay rights and entitlements,

following a Labour Court recommendation. JP confirmed NPH has rejected the claim under contract.

Nevertheless, JP explained it is an industry-wide issue and some contractor is likely to take legal action,

the ruling of which will impact NPH. JP explained it needs to be closed as part of wider Government

approach. JP agreed to estimate the financial risk and the likelihood of the risk based on the contract

terms for the next CHP&P Steering Group meeting. Action

Carpark Charges

LW noted John Hennessy, National Director Acute Strategy and Planning, HSE, estimated 6-8 weeks for

the national review of car park charges.

JGC noted the recommendations of the review could impact the viability of the carpark business case.

SM noted the more aggressive the charging model included in the business case, the greater the risk is

that the national review of car park charges will impact its financial viability. JP confirmed the charging

model used in the business case is based on St. James’ Hospital existing parking charges to ensure an

aligned campus approach.

Education Funding

FD confirmed a follow up meeting between the Department of Health, HSE, NPH, Department of

Education and the Higher Education Authority is taking place 2nd

May to discuss the extent and timing of

their capital contribution.

Philanthropic Funding

EH confirmed the paper on philanthropic funding is on track for completion by end April and will be

presented at the next CHP&P Steering Group meeting. EH noted it will need to be reviewed in advance by

the CHG Board and the Hospital Foundation Boards.

Funding Risk

SM presented a paper providing overview of supplementary items associated with the new children’s

hospital and the related financial risks, outlining the size of the risk, the risk manager and the risk owner.

RMHC Family Accommodation

JGC asked for clarification as to whether the proposed HSE funding for the RMHC family accommodation

would be taken from the HSE capital budget. SM confirmed this would be the only option, noting that the

Exchequer capital budget is already significantly under pressure.

CD noted discussion would be required with the Department of Health prior to any decision on the use of

Exchequer capital budget.

CD asked if the HSE will subsidise operational costs. SM confirmed it will not.

JGC noted upfront capital funding is preferable to funding running costs in perpetuity.

JS confirmed the HSE will own the RMHC family accommodation building and already own the land.


V1.0 Page 4 of 5 [

Cashflow Analysis

JP described cashflow gaps presented in letter (11th April) responding to Jim Curran (limited circulation).

SM noted efforts to manage cashflow will need to be within the programme; HSE does not have sufficient

cash available.

JGC asked if capital spend could be reprofiled towards later years when surplus cashflow is available. JP

explained this would prolong programme duration, delay programme completion date and increase overall

programme costs.

SM suggested possibility of securing supplementary funding – e.g. €47m for carpark, €20m for sprinklers

– earlier than planned and using to offset anticipated cashflow gaps.

CD noted this degree of cashflow differences between HSE and NPH is unexpected. CD agreed to

convene sub-committee to resolve before next CHP&P Steering Group meeting, consisting of CD, TCO,

JP, SM (optional) and Jim Curran. Action


JP and EH flagged issue with capacity of Connolly adult hospital laboratory to service the Connolly

satellite, as initially planned, due to increased activity levels absorbing capacity. Negotiations are in

progress with General Manager of Connolly hospital and a solution is required in next few weeks. Agreed

to examine at the next CHP&P Steering Group in more detail if a solution cannot be reached. EH noted

this is the highest priority issue for the Connolly OPDUCC.

JP noted status of dependency on use of HBS framework to support equipment procurement for satellites

is now on track, following approval by HBS.

7. Update on National Paediatric Model of Care (MoC)

TCA confirmed the resource costing for the elements of the MoC critical to enable the new children’s

hospital is complete. It will be presented to the MoC Steering Group, led by Dean Sullivan, Chief Strategy

and Planning Officer, HSE, on 26th April. It will then be presented to HSE Leadership for approval and,

following this, the CHP&P Steering Group for observation.

TCA noted for clarity the MoC work to date does not consider prioritisation for implementation.

HB noted the full implementation plan will probably be a 10-year roll out.

FT asked if there are ICT implications that need to be considered.

TCA confirmed ICT, equipment and capital implications are out of scope, except for transport.

EH also noted change and project management costs for implementation have not been included.

Some concern noted that these elements have not been considered.

TCO requested visibility of MoC costing document before it is presented to HSE Leadership.

JGC asked TCA to liaise with DS to arrange a briefing session before the MoC costing is submitted to

HSE Leadership, to provide an opportunity for relevant members of the CHP&P Steering Group to provide

observations and discuss concerns raised. Action

MO’C suggested it would be useful for the MoC to be embedded in Sláintecare. HB confirmed this is so.

8. Standing Update on EHR & ICT

Acute EHR Business Case

MO’C confirmed substantial progress on the Acute EHR business case.

MC, JGC and EH also acknowledged work of FT and team to progress the Acute EHR business case.

MO’C confirmed DoH observations have been incorporated into the Acute EHR business case.

MO’C confirmed Acute EHR business case was shared with DPER on 23rd

April for information.

MO’C confirmed DPER peer review group has been set up and will meet on 30th April.

MO’C confirmed overall timeline is currently back on track.

FT agreed to issue copy of Acute EHR business case to JGC following meeting.

FT noted next critical step is Statement of Requirements (SOR), which needs to be approved by 10th July.

MO’C noted the Acute EHR business case already provides a high-level outline of SOR.


V1.0 Page 5 of 5 [

CHG Acute EHR Contingency Plan

JGC deferred the discussion on the draft CHG Acute EHR Contingency Plan until the next CHP&P

Steering Group meeting to allow members time to review and submit queries. Action

Medical Devices Integration

FT confirmed from national EHR perspective, OoCIO will go to market requiring vendors to have a

standards-based approach to integration.

FT explained CHG can set requirement for compatible devices when procuring new equipment which will

address most medical devices integration.

FT noted the concern is with legacy devices. SM noted the problem of legacy devices should become less

as large devices in individual sites become aged and are replaced. SM suggested assessing the presence

of legacy devices when evaluating site readiness during the national Acute EHR roll out. SM suggested

OoCIO consult with Ger Flynn, National Clinical Head of Medical Devices, HSE, in due course to examine

this in detail.

MO’C confirmed interoperability is assured from the national Acute EHR perspective.

Agreed the medical devices integration issue is closed.

MedLIS

EH noted CHG received communication that MedLIS is not on track for new children’s hospital in 2022.

SM advised MedLIS is significantly behind and a revised plan should be complete in 3-4 weeks.

EH noted it would be a significant issue if CHG had to move to a contingency for the main hospital.

Agreed to make this an agenda item at the next CHP&P Steering Group meeting. Action

NIMIS

EH noted some operational challenges with NIMIS which pose difficulty for Connolly opening.

EH asked if it is possible for scope of Temple Street to include Crumlin. SM advised this is not possible.

Agreed to provide update on this at next CHP&P Steering Group meeting. Action


CD confirmed meeting with NDFA took place 19th April. CD noted NDFA were interested in governance,

scale and technical aspects of the programme but gave no indication of willingness to be involved.

JP and EH confirmed the MES timeline has been re-evaluated; the cut-off point for DPER approval is

September 2018; beyond this MES is no longer viable because of the time it takes to procure.

JGC asked what drives the September 2018 cut-off point. JP explained a tender notice needs to be

issued in September 2018 in order to start competitive dialogue in January 2019; this will run for 18

months and then a preferred vendor will be appointed; the vendor will require 12 months to build

equipment in order to provide in time for contractor timelines.

CD commented that the September 2018 cut-off point is very challenging and suggested external advisors

should be explored, recognising that the NDFA would be preferred by DPER. CD agreed to try get an

indication from NDFA about willingness to be involved within the next week.

FD noted the capital funding allowance for possible MES equipping in the last memo to government was

€65m. FD asked whether this is still accurate. JP confirmed it needs updating; 250,000 approx. equipment

items have been identified in detailed design from C-Sheets and these need to be estimated using

existing HBS pricing, proposed to include with memo for information to government in summer. Action


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Date 15:00-17:00, 31st May 2018

Location Department of Health, Hawkins House, Hawkins Street, Dublin 2

Chair Dean Sullivan (DS) Deputy Director General, HSE

Attendees



Martin Curley, (MC) Chief Information Officer, HSE

Colm Desmond (CD) Assistant Secretary, Finance & Evaluation, DOH






Dean Sullivan (DS) Deputy Director General, HSE



Dara Carroll (DC) Integrated PMO for CHP&P Steering Group, HSE

Margaret Giffney, (MG) Integrated PMO for CHP&P Steering Group, HSE

John Smith (JS), National Director Health Business Services HSE


Lynda Sisson, (LS) Consultant and Accredited Specialist in Occupational Medicine

Apologies








DC to reflect comments to the previous minutes. Final document to be circulated by 1st June 2018.

DS introduced himself as the new Chair, CHP&P SG and outlined his brief as Chair. DS noted thanks to

Sadhbh OBrien for her input and support to the steering group as she has moved on to a new position

and welcomed DC.

2. Standing update on Integration

The integration paper submitted is organised by the releases that the Children’s Hospital Programme

PMO is using to structure its work: Commencement, Central Referrals Pilot, Connolly Paediatric

Outpatient and Urgent Care Centre, Tallaght Paediatric Outpatient and Urgent Care Centre, new

children's hospitals with prominent attention to the first opening facility, Connolly Hospital.

EH outlined progress is proceeding, with no exceptions.

EH noted that a meeting was held with DOH Sec Gen 25th May and Chair of CHG Board to discuss the

legislation.

EH noted that the Sec Gen will meet with the Chairs of Temple Street, Crumlin, Tallaght, and Children’s

Hospital Group Board on 8th June to address queries and outstanding issues related to the

commencement of the legislation.

EH noted the Integration Programme has been signed off by the Children’s Hospital Group. A Work

Breakdown Structure has been prepared for the allocated €85m and this programme is reported on

through its PMO against releases.

CREMINS

Typewritten Text

PAC32-R-1939(x) B Meeting 14/02/2019


V1.0 Page 2 of 4 [

EH noted that the Critical Pathway had been completed, which included the detail around the various

interdependencies.

DS requested that, in order to facilitate a streamlined Steering Group meeting update, an Integration

Plan, with clear deliverables (2018 to 2022) be prepared, against which positive assurances would be

provided by CHG at the Steering Group meetings going forward.

TC noted that the DoH would welcome such a formalised plan.

FD noted that the Children’s Hospital Programme Investment Case (last version Feb 2017) could be

updated, with a refreshed profile of expenditure and deliverables (for next 5 years).

It was agreed that an Integration Plan (2018-2022) with key milestones within the current critical path and

expected resources be prepared and circulated by CHG prior to the next Steering Group meeting.

ACTION

3. Standing Update on EHR & ICT (MedLIS, NIMIS, etc.)

Acute EHR

MC outlined that progress has been made for Acute EHR Business Case Review with very constructive

engagement at second peer review.

DS welcomed this progress, queried what risk mitigation plan is in place for EHR.

FT stated that the business case for EHR is on track with the new children’s hospital being the first

deployment. The Peer Review is progressing and DPER needs to formally approve the Business Case. A

first draft Statement of Requirement by Aug is being prepared and Noel Carbury CHG EHR Project

Manager as assigned to lead this for the HSE.

FT confirmed mid to end of August for 1st Drafts of SOR, with resources being added to catch up c. 3

week delay.

It was agreed that start Sept 2018 remained the critical path date and FT states confidence that this date

was achievable.

MC noted ongoing discourse around governance, with some feedback coming through the Peer review process. DS and MC agreed to meet wk 4

th June to discuss EHR and associated contingency. ACTION

TC noted DPER seeking assurance around governance and accountability. An update of Governance and

Accountability will also be required at the next CHP&P board meeting on 20th June 2018.

MC, MO’C and DS to meet around Governance, and Assurance wk 4thJune. ACTION.

Further to query by MC, it was agreed that the roll out of National EHR will not be paediatric specific and

will encompass the adult EHR, but that the NCH will be the 1st site in which it will be implemented.

EH noted that clinical engagement involving adult community is vital and is being led by Noel Carbery

throughout July and August ’18. FT noted that some delay was due to engagement outside of paediatrics.

LW has written to hospital groups for nominees to ensure the acute system functional requirements are

met.

DS concluded by noting that EHR was complex and challenging, with associated risks, however, based

on discussion, will succeed if procurement is initiated in Sept ’18.

PAS

FT outlined that the iSoft solution set for PAS is functioning for CUH.

EH advised that a single PAS to be operational in Crumlin, Tallaght paediatrics and Temple Street, but

agreement required with the adult service in Tallaght on key interfaces. This risk is currently being

actively manged by CHG.

DS asked that MC, FT and EH to form a working group to review issues in relation to PAS and NIMIS.

Any material risk to be brought before this steering group. ACTION

DS noted that the risk is being actively managed. No further discussion required at steering group.

SM outlined the MedLis and NIMIS update paper, Medlis replanning is going well, resourcing national

project team in relation to Phase A sites; Cavan General, Beaumont, St James’s and Mater.

Confirmation of nch implementation after 1st roll out NIMIS allows for localised workflow configured at

hospital level. Paper is prepared for discussion at meeting week 4th June around CHG radiology working

group.


V1.0 Page 3 of 4 [

Interoperability project plan needed from FT/MC for Connolly facility. ACTION

EH noted the need for the converged network implementation and testing 15 months before NCH

opening.

4. Standing Update on Pre-CAR

EH noted that the final report and Action Plan is complete and has been circulated to selected steering

group members and to the CHP&P Board in advance of their June meeting. The Action Plan contains 29

items, resolution on some items may not be until 2019. The CHG Executive is taking a lead role on

progressing the actions.

EH noted that Key milestone as the Establishment of Legal Entity, with a Commencement date Jan ’19.

EH noted that a high-level symposium is scheduled for 4th July for Governance of the hospital Boards and

CHGB.

TC noted Sec Gen preferred approach for a phased commencement of legislation commencement. A

meeting between Sec Gen and Chair of CHG Board took place on 25th May. Agreement on best

approach for legislation with the three hospital boards and CHG is required prior to submission of the Bill

to government in early July ’18 seeking permission to publish.

EH noted the importance of maintaining the 1st January 2019 as the date for commencement. Matters

such as staff recruitment and equipment handover require adherence to this date.


LS advised there were no HR items for escalation at this time, staff engagement progress is ongoing.

DS requested a workforce plan to be presented to the next meeting outlining the ramp-up arrangements

for staffing to opening of NCH in 2022. ACTION

MO’C noted concern around the nursing intake in third level education as the current flow will not

generate the required 300 new paediatric nurses in 2022. EH noted that the National Children’s Nursing

Workforce Plan (final draft) will be ready 1st June 2018 - which is to address the future supply of paediatric

nurses. Similar challenges exist in relation to junior doctors and AHP’s. EH noted ongoing interface with

D.E.S.

EH highlighted the importance of the Model of Care in completing the staffing plan.

DS noted the nursing capacity is to increase by 20% year on year. SM noted NDP (HSE) require a budget

increase from DoH for this purpose.

TC noted clarity required around MoC and staffing recruitment deadlines in order to plan for adequate

numbers of graduates for 2022.

DS requested a paper for the next SG meeting from LS on increased training requirements. ACTION

SM noted that retaining graduates is a key challenge and we require innovative ways of retention before

they move away overseas.

EH advised that innovative methods were being explored in relation to affordable accommodation for key

workers. CHG and NPHDB are working on proposals in this regard. EH to outline progress in a paper to

Steering Group meeting in August ‘18. ACTION


JP reported progress in relation to the Guaranteed Maximum Price (GMP) programme. All design

packages issued by QS to contractors for final measure of quantities and pricing. An independent expert

will deliver binding decision on disputed construction costs. Deadline end-June will not be met for

concluding GMP process. End of June NPH will have a strong sense of where we stand in overall terms

for Capital Construction Cost. July and August to work through identified issues, make any changes to

contract documents and firm up on GMP. September NPH QS to produce a Final GMP Report. NPHDB

Board will then meet to approve and to allow Dept to bring a memo to government in October for decision.

TC advised to go to government for decision before the 2019 Estimates process, September would be

better than October.

SM requested an approximate figure be adjudicated on by mid-July (before estimates process closed) to

allow DPER and Government to maximise position.


V1.0 Page 4 of 4 [

EH outlined the philanthropy challenges being faced with the merger of three separate foundations into a

single entity contingent on Legal Commencement January 2019. EH to provide a philanthropy review for

August SG meeting. ACTION


JP reported that work at the Connolly Hospital site is progressing well and is on track for 2019

completion. Report due in relation to solution for shared Connolly Laboratory is due on 1st June. Tallaght

decant and crèche buildings are on track for completion in July 2019.

EH advised discussions about specific aspects with Universities are commencing but no firm commitment

about 3rd

Level education.

FD advised there is no government commitment to fund the RMHC family accommodation unit, so there is

a €7 capital shortfall. SM noted that RMHC is putting resources into all operating costs as well as €8m

capital costs. SM to provide update paper (prepared by Paul de Freine / Tony Kelly, HSE Estates) for next

meeting. ACTION

CD noted HSE could use current funding for capital purposes up to certain minor agreed limits.

It was agreed that family accommodation was critical and how to pay for it needs resolution. CD/DS to

discuss. ACTION

8. Update on Paediatric Model of Care (PMoC)

A draft paper has been produced for HSE Leadership which will come to CHP&P Steering Group meeting

on 25th June ’18.


CD outlined progress on CBA and the business case. Document identifying 3 equipment strands to go to

DPER by July ‘18. Single equipment business case will be issued to Steering Group by August ’18, then

to DPER by August/September. This will be reflected in the Memo for Government.

SM queried whether the funding (€65m) was categorised as revenue or capital, this has to be confirmed

ACTION.

DS requested key procurements and key milestones for July ’18 SG meeting. CD, SM (HSE) to

progress. ACTION

10. AOB

FD asked if the CHP expenditure document is relevant to this meeting. We need to plan around

integration and costs.

SM requested that EH attach a definition to Revenue Expenditure Update. ACTION

EH noted the Children’s Hospital Acute EHR Contingency Plan document was included as a request from

the last meeting.

Mo’C requested we capture documents in today’s pack that were not formally tabled or discussed today.

These included CHG Acute EHR Contingency Plan,the NIMIS Impact Paper and some financial papers.

Meeting Close

Next meeting Monday 25th

June 3.30pm, Green Room, Dr Steeven’s Hospital, Dublin 8

Documents

Sarah Cremin - Dáil Éireann · 2019. 3. 13. · John Pollock, Project Director, NPHDB (JP) Apologies: Rosarii Mannion, National Director of Human Resources, HSE (RM) Richard Corbridge,