The Nightmare that is the HSE

This came to me from a colleague who is a solicitor in Clonakilty. Upon reading it I was so infuriated that I had to share it straight away:

“Hi Neil,

The HSE was in the news yesterday when a report prepared for the organisation itself last year became public which showed how money is spent and wasted within the HSE.

The HSE is a Frankenstein’s monster of former regional health boards that were cobbled together in the vain hope of achieving those illusive goals of so many mergers: you know, the good stuff like synergies and economies of scale. Of course, in fact what happened was an explosion in the ranks of middle management within the new organisation, out of all proportion to the front line staff actually required to deliver health care services to the public. And this middle management is for the most part completely anonymous and unaccountable.

The HSE’s attitude to court proceedings exemplifies this. There was a little reported incident in the Supreme Court back in April where an appeal by the HSE of a High Court decision came on for hearing.

The original case was a District Court case in which a mother had had her children taken from her by the HSE when it applied for an order ex-parte (that means without having given any notice to her or allowing her to be heard at the initial court application). After the order removing the children had been made ex-parte, the mother had an opportunity to put her side of the case (she engaged lawyers for the purpose) and her children were ultimately returned to her in proceedings that involved 9 court appearances.

The mother sought to have her lawyers’ costs paid by the HSE. The HSE objected.

The mother was poor and the HSE argued that she would have qualified for legal aid if she had applied for it. The HSE’s perverse reasoning was that if the mother would have qualified for legal aid but choose to retain lawyers privately, the HSE should not be obliged to have to pay her lawyers costs of the draconian proceedings to remove her children which had been brought unsuccessfully by the health service.

Think about this for a moment; if the woman had not been poor and had not qualified for legal aid, the HSE would have had no argument. She would have been entitled to chose whoever she liked as lawyers and would have been obliged to pay them. And the HSE would have been liable for their costs of the unsuccessful proceedings.

However, because she was poor the HSE felt she should not have had that choice and should have been obliged to pursue her case through legal aid. (In case you’ve never had to deal with legal aid, it is a system that is ridiculously under-resourced and over-worked and extraordinarily slow as a result. if your kids were taken from you, you might not wish to take your chances on however long it might take the legal aid system to get to you.)

Anyway, the High Court saw through all of this and found among other things that the HSE’s argument effectively meant persons of limited means would have to justify their choice of lawyer in a way wealthier people would not despite, or because of, the fact they were not seeking State assistance.

But that High Court decision was in April 2013; last year.

In April of THIS year, the appeal of that decision came before the Supreme Court. Yes, you read that correctly: the HSE appealed that decision to the Supreme Court.

In the meantime, the District Court had granted the mother her costs pursuant to the High Court decision and in any event there had never been any factual evidence provided to the District Court in the first place in relation to the mother’s means, it was simply taken for granted that she was of limited means.

On 29th April of this year the appeal opened before what must have been a quite puzzled 5-judge Supreme Court.

At the outset of the appeal, several of the Supreme Court judges made clear the issues before the court were confined to the particular facts of this case and there was no factual basis for the claims by the HSE concerning the mother’s entitlement to legal aid, including no evidence before the District Court the mother would have qualified for legal aid.

Mr Justice Adrian Hardiman remarked that this appeal was being run at public expense, but the issue the HSE wanted decided was not set out in the case stated from the District Court.

Before anybody said anything, before any legal arguments whatsoever were made in the appeal, the lawyers for the HSE asked for (and were given) a moment to take instructions from their client.

They returned to advise the Supreme Court that the appeal was being withdrawn.

But that is not the end of the story. In the meantime, there were 24 OTHER cases that the HSE had appealed from the District Court to the Circuit Court pending the outcome of the Supreme Court appeal in case above. All of which presumably fell away after this case was withdrawn, but not without considerable delay, uncertainty and considerable expense of each of the parties (and remember each of these cases concerned a family threatened with having children in care of the health service).

This may seem like a tale, told by an idiot, full of sound and fury, but signifying nothing. However, it is but the merest glimpse into the bizarre reality that is litigation in the world of the HSE.

Citizens’ rights, lives and liberties are continually being put at stake by the decisions of people who are completely unaccountable to anyone and are very rarely the subject of scrutiny and it is all done at exorbitant cost with obscene waste while on the face of it (as was the case in this case) the justification for everything is the saving of money and reduction of cost.

Do not be surprised as the nightmare that is the HSE keeps on recurring.

All the best,

Florence McCarthy
Managing Partner
McCarthy & Co.


Thanks for that eye-opener, Flor. The story of the report into the expenditure by the HSE can be found at

About Neil van Dokkum

Neil van Dokkum (B. SocSc; LLB; LLM; PGC Con.Lit) Neil is a law lecturer and has been so since arriving in Ireland from South Africa in 2002. Prior to that Neil worked in a leading firm of solicitors from 1987-1992, before being admitted as an Advocate of the Supreme Court of South Africa (a barrister) in 1992. He published three books in South Africa on employment law and unfair dismissal, as well as being published in numerous national and international peer-reviewed journals. Neil currently specialises in employment law, medical negligence law, family law and child protection law. He dabbles in EU law (procurement and energy). Neil retired from full-time practice in 2002 to take up a lecturing post. He has published three books since then, “Nursing Law for Irish Students (2005); “Evidence” (2007); and “Nursing Law for Students in Ireland” (2011). His current interest is the area of disability as a politico-economic construct. Neil is very happily married to Fiona, and they have two sons, Rory and Ian.
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9 Responses to The Nightmare that is the HSE

  1. SAFE AMP says:

    I have no trouble at all believing that the HSE waste public monies and this is a very good if sad example. This is also the same HSE whose first priority on one being admitted to a public hospital is to determine whether or not one has private health insurance. If you have the misfortune to admit to having insurance, then you are badgered until you sign the appropriate piece of paper so that they can claim costs from the private insurer. In the case of the elderly this almost amounts to elder abuse. Now it becomes clear why the cost of health insurance is so high. Anyway, keep up the good work Neil.


    • Neil van Dokkum says:

      Thanks Margaret. I am also informed that if you have health insurance the HSE will charge up to ten times for a room what they would have charged somebody without insurance. If that is not insurance fraud, I don’t know what is.

  2. dave says:

    Thanks for sharing that, a very interesting insight.

  3. Maria Fleming says:

    Hi Neil, we admire all your hard work in the fight against Eirgrid. We thought you might be interested in our latest post

    All the best, Maria Fleming and Paul Cole on Save Josie’s home.

    • Neil van Dokkum says:

      Hi Maria and Paul
      Keep up the good work. I will spread this far and wide. My best wishes to Josie.

  4. Maria Fleming says:

    Thanks for your comment and for sharing the post. We wrote one more post today, that we think you will enjoy. We do not know how Eirgrid’s legal team let the passage in the email slip through, but we bet they will regret it very much tomorrow morning when they get into the office.

    On another note we have identified Fintan Slye, Sean Meagher and Graham Parker as members of the Engineers Ireland and we are planning to make a formal complaint against them. They have told us many lies, often with witnesses. If you have any tips on the best way to write this, we would be very grateful. But only if you have time, as we know you are very busy. Kind Regards, Maria and Paul

    • Neil van Dokkum says:

      Hi guys
      I think it was on my blog called “The Ethics of Objectivity” that I detailed how you could make an ethical complaint to Engineers Ireland.
      A complaint does not have any special format, just stick to the facts and if you have names, dates and places they will make the complaint more credible. Keep it up, the lies and corruption must be exposed.

  5. Neil van Dokkum says:

    Hi Neil,
    I had a lot of response to the HSE mail last week. One of the most interesting (and depressing yet completely unsurprising) came from my old friend and regular correspondent David who is a man who knows a thing or two about a thing or two in this area. David is a serious IT systems expert (there is probably a far better and more precise description for this, but if so it is beyond my ken) and his business has a large federal healthcare practice in the US. So, he kind of knows what he’s talking about.

    I think the simplest thing is to quote his email verbatim and in full:
    “Hi Flor, From my perspective: the HSE has 1700 (yes one thousand seven hundred) separate computer applications that manage its finances. (source PA Consulting). And many of them are quite unconnected. Further there is no common chart of accounts or financial reporting structure. In systems terms this is outrageous, dereliction of responsibility. It’s no wonder they cannot manage to keep within budget; and that the health costs of Ireland are one of the highest in the developed world.

    Jesus wept…
    All the best,

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