Health Service Executive Annual Report and Financial Statements 2020 Health Service Executive Annual Report and Financial Statements 2020 About This Report This Annual Report describes the performance and operation of the Health Service Executive during 2020. It has been prepared according to legislative requirements and is arranged as below: PART I Section 1: Foreword Outlines our key messages through the Statement from the Chair of the Board and the Chief Executive Officer Review Section 2: Strategic Context and Direction Describes the exceptionally challenging context in which services were delivered in 2020 and outlines our longer-term vision and direction Section 3: Operational Delivery Describes how services were delivered during 2020, summarises performance against our National Service Plan 2020, and elaborates on the key enablers for making change happen Section 4: Our Management and Accountability Provides an overview of key governance and accountability arrangements within the HSE, including a Board Members’ Report and Risk Management Report for 2020 Appendices Includes a description of our organisational structure and the mechanism through which services are delivered, a report on expenditure and Human Resource data, a report on the National Service Plan 2020 scorecard and key activity, a report on capital infrastructure, a schedule of Board and Committee attendance, fees and expenses, a checklist describing how legislative compliance has been met within this Annual Report and a glossary/list of acronyms PART II Financial Governance Sets out our financial governance including the Annual Financial Statements Contents 1 Contents PART I Section 1: Foreword 1.1 Statement from the Chair of the Board 4 1.2 Chief Executive Officer Review 6 Section 2: Strategic Context and Direction 2.1 The COVID-19 Environment 12 2.2 Health of Our Population Informing Service Delivery 14 2.3 National Service Plan and Capital Plan 2020 16 2.4 Our Corporate Plan – Looking Forward 17 2.5 Preparing for Brexit 18 Section 3: Operational Delivery 3.1 COVID-19 Impact and HSE Response 22 3.2 Restarting Services and Delivering non-COVID-19 Care in 2020 29 3.3 Performance and Key Achievements in 2020 31 3.4 Ensuring the Quality and Safety of Our Services 39 3.5 Enabling Healthcare Delivery 42 Section 4: Our Management and Accountability 4.1 Governance and Board Members’ Report 2020 50 4.2 Risk Management Report 62 4.3 Complaints and Compliments 69 Appendices Appendix 1: Organisational Structure and Service Delivery 74 Appendix 2: Expenditure and Human Resource Data 76 Appendix 3: National Service Plan 2020 National Scorecard and Key Activity 78 Appendix 4: Capital Infrastructure 84 Appendix 5: Schedule of Board and Committee Attendance, Fees and Expenses 87 Appendix 6: Legislative Compliance 90 Appendix 7: Glossary/List of Acronyms 91 PART II Financial Governance Operating and Financial Overview 2020 96 Statement on Internal Control 104 Comptroller and Auditor General Report for Presentation to the Houses of the Oireachtas 124 Financial Statements 129 Notes to the Financial Statements 134 Appendices 168 HSE Annual Report and Financial Statements 2020 1 Foreword 1.1 Statement from the Chair of the Board 1.2 Chief Executive Officer Review HSE Annual Report and Financial Statements 2020 4 Statement from the Chair of the Board 1.1 Statement from the Chair of the Board As Chair of the HSE Board, I and my colleagues are pleased to submit the HSE Annual Report and Financial Statements for 2020. At the beginning of 2020, Ireland was reporting the fastest improving life expectancy in the European Union (EU), and our people were self-reporting the best health in the EU. However, the service was at its limit and waiting times and trolleys were a sign of that strain. To address that, progressive reform was underway in a number of areas aligned with Sláintecare policy, from service developments to enhance the experience of patients, to new ways of working changing the way services were delivered, underpinned by tighter financial disciplines. The HSE Board was in place to provide improved oversight and strengthened governance, and development was underway of a new Corporate Plan to outline our vision and set our objectives for the next three years. The focus of all our efforts was on the provision of safe health and social care services, and on addressing long-standing challenges for the health service, including long waiting lists for scheduled care in hospitals and long waits in emergency departments, particularly for older people and those who have more complex needs. Other challenges included an over-reliance on residential models of care and lack of sufficient services to enable our ageing population to maintain their independence and live well in the community. Waiting times for mental health services for children and adults, long waits for community-based services such as therapies, and insufficient availability of home-based person-centered support for people with disabilities and their families were also a significant concern. The emergence of COVID-19 changed the focus of healthcare systems in Ireland as it did throughout the world. Over the year, we have seen the most extraordinary of responses from both the public and from staff across the HSE. On behalf of the Board, I am deeply grateful for the support of the public and the hard work and dedication of every member of our staff, in particular those who are working tirelessly on the frontline. General practitioners, pharmacists and other community-based workers also deserve our thanks as does everyone working in our section 38 and 39 partner organisations. We also owe thanks to stakeholders, representative bodies, regulators and officials in the Department of Health (DoH). Guided by public health advice teams, we will continue to maximise the delivery of high-quality health and social care services in a COVID-19 environment. As part of the response to COVID-19, a range of innovative initiatives were put in place by the HSE and the opportunity now exists to take forward those changes which should be retained in the future. Doing so will ensure that we capitalise on the gains that have been made during the crisis, minimising long-term impacts for patients and staff while maximising value. With the availability now of effective vaccines, we must continue to be mindful of and to mitigate the risk that COVID-19 poses to ‘normal’ healthcare activities. The very significant budget allocation for the health service in 2021 underlines the strong strategic alignment that now exists between the HSE, the Minister for Health and his Department. We are pleased that the investment that is being entrusted to the HSE gives us the means to provide improved services for people in Ireland and are determined to progress important strategic reforms. We are investing in initiatives that we consider most likely to deliver demonstrable improvements to health service performance and delivery and have also prioritised the mitigation of the most significant risks for the HSE as identified in our Corporate Risk Register. HSE Annual Report and Financial Statements 2020 Statement from the Chair of the Board 5 With an increasing population who are living longer, it is crucial that the health services effectively plan for future healthcare needs. We have to earn the right to continued investment through 2021 and beyond by demonstrating the impact and benefit of the new model of health and care in line with Sláintecare and as defined in our Corporate Plan. New ways of delivering services bring great opportunities and will ensure that future healthcare in Ireland remains of the highest quality, with the patient placed at the heart of all we do. As we continue to live with COVID-19, thanks to the strong social solidarity of our people we do so with hope and optimism for a better future but hold those no longer with us in our hearts. On behalf of the Board and the HSE, I express my sympathies to all those who have experienced loss and suffering over the past year. I would like to thank sincerely all the Board members who served during the year for their commitment and valued contribution as well as those who gave their time to our Board Committees. I would also like to thank the Minister for Health and his officials for their support in the shared challenge, and of course our Chief Executive Officer (CEO), Paul Reid, his management team and all our HSE colleagues who have worked so well, so hard, and so innovatively through the past months. I look forward to our continued collaboration, striving to provide the health service that our population deserves. Meitheal de dhíth arís. Ciarán Devane Chair HSE Board HSE Annual Report and Financial Statements 2020 6 Chief Executive Officer Review 1.2 Chief Executive Officer Review I am pleased to publish the HSE Annual Report and Financial Statements 2020. 2020 was a year like no other, not just for our health service, but for the entire nation. As news of the devastating COVID-19 virus began emerging early last year, images from Wuhan, China, and Bergamo in Italy served as a stark warning of the challenges that lay ahead for our health service and to our way of life. As an organisation we prepared carefully for the virus that was spreading across the globe with early discussions focused on creating extra beds within our existing hospital infrastructure and using private hospitals. However, we did not know the scale of what was to come – for example, the HSE was required to work in exceptionally difficult circumstances to secure unprecedented levels of Personal Protective Equipment (PPE) to protect frontline workers. Prior to the pandemic we were spending €15m a year on PPE.