HSE to prioritise "time-critical" and "urgent" care as thousands of appointments cancelled due to hack 1 month ago

HSE to prioritise "time-critical" and "urgent" care as thousands of appointments cancelled due to hack

HSE CEO Paul Reid said that health services across the country will be impacted into next week.

The Health Service Executive (HSE) has told staff members to protect "unscheduled and urgent care” and "time-critical" treatment as they continue to deal with the fallout from a recent cyber attack.


In a memo relating to clinical guidance, attributed to the office of Chief Clinical Officer Dr Colm Henry, they said that the advice is “underpinned by the need to prioritise patient safety and is focussed on unscheduled, urgent and time-critical care”.

"However, it is critical that this is monitored on a daily basis at service level to enable those services that can deliver scheduled care to do so," he added.

“Additionally, while the duration of the attack and time to recovery is currently unknown, it is important to remain mindful of the scheduled care that could become urgent care or result in an adverse outcome e.g. non-continuation of certain types of radiotherapy, if it does not proceed.”

The principles shared in the document are: 

  • Prioritise patient safety
  • Protect unscheduled and urgent care
  • Ensure continuation of time-critical care and treatment e.g. dialysis, surgical procedures, radiotherapy
  • Ensure involuntary admissions in Mental Health Services are conducted as safely as possible
  • Enable staff to work as safely as possible in the absence of usual digital support and enablement

The risks inherent in the absence of current IT and digital systems listed in the document include:

  1. Limited access to diagnostics,
  2. Absence of access to historical records - clinical, radiological, laboratory - thus disabling comparisons with previous records and increasing the risks associated with ‘point in time’ information rather than longitudinal information,
  3. Delays in processing of information because of need for hand-written as opposed to IT generated reports.
  4. Intensely stressful environment for staff making decisions without access to many of the usual supports
  5. Transcription errors in the recording of hand-written results e.g. blood results, radiology results.
  6. Data protection issues and potential breaches of GDPR, which must be managed in the context of the immediate priority of managing clinical risk to the patient.

The HSE will be updating the document roughly every 72 hours.

Thousands of appointments have been cancelled due to the cyber attack throughout the week.

Earlier in the week, CEO Paul Reid said that the HSE does not have an indication yet in terms of what patient data has been accessed and confirmed health services across the country will be impacted into next week.

The HSE CEO also echoed Taoiseach Micheál Martin's comments that a ransom has been sought, but will not be paid.

According to Reid, the HSE made "steady and safe progress" overnight in assessing the damage of Friday's cyber attack and working to regain control of its IT system.


Early on Friday, the HSE announced it had temporarily shut down its IT system after it was targeted in a "significant ransomware attack".

Described as possibly the most significant cybercrime attack on the Irish state by Minister of State for eGovernment Ossian Smyth, it has caused major disruptions to health services across the country.

Speaking on RTÉ's Saturday with Katie Hannon, Reid explained: "Teams have been working throughout the night... The best way to describe it is they've made steady and safe progress overnight."

The CEO said this involved re-gaining access "to the base layer" of the HSE's network, identifying the nature of the attack and looking into what systems could be brought back in a safe manner.


Reid stated that the cyber attack was "most likely" carried out by an international criminal organisation and echoed Taoiseach Micheál Martin's comments on Friday night that a ransom will not be paid to the perpetrators.

He said: "No State wants to leave its national infrastructure exposed to ransoms and that's exactly what these organisations set out to do."