The HSE cyber attack was a "landmark event" in Ireland - has it learned from the experience?

The Republic of Ireland’s Health Service Executive (HSE) was the subject of a large-scale cyber attack in 2021 that disrupted clinical operations and the IT systems in hospitals across the country.

Three years later, and the health service is still dealing with the fallout from the attack, with more than 473 legal proceedings being taken against the organization since.

In addition, RTÉ News reported that there were another 140 pre-action letters issued to the HSE, and the State Claims Agency (SCA) continues to manage 12 personal injury claims launched against the body.

An investigation of the breach carried out by the US’s Department of Health and Human Services published (HHS) in March 2022 uncovered serious IT vulnerabilities.

The investigation also found the HSE “missed opportunities for efficiencies in the recovery of systems applications due to a lack of preparedness”, indicating it still has some way to go in improving its approach to cyber security.

On 8 May, during a debate, the Irish Seanad was told the HSE was still using the out-of-date Windows 7 operating system (OS) on some of its devices, and was also struggling to fill senior cyber security roles permanently.

For example, both the CISO and CTTO roles have only been filled on an interim basis and the HSE is still looking for permanent replacements to take the organization’s cyber strategy forward.

The recent revelations suggest that the health service still has much work to do with regard to cyber resilience, security experts told ITPro.

Commenting on whether the HSE had learnt from the 2021 attack, Ciaran Lutrell, VP of Global SOC Operations at MDR specialist eSentire, said that while mitigating cyber risk is not such a simple task for an organization of the HSE’s size, the public has not received any details of how body has responded to the incident.

“Has the HSE learned its lesson? The scale of the challenge in mitigating cyber risk across such a vast IT infrastructure cannot be understated,” Lutrell said.

“While there is undoubtedly more attention focused on addressing core issues, we have not been given any specifics of how the HSE has measurably improved its cyber resilience and overall cyber security posture which would bring confidence in it being able to withstand and recover from a similar attack.”

HSE attack a “landmark event” for cyber security in Ireland

The 2021 attack resulted in widespread disruption to clinical services across the Republic of Ireland, with some areas seeing a 80% drop in the number of appointments.

There has been no evidence of the information accessed by the group being used in scams or fraud, according to the health service, which said it had notified 90,000 people as a result of the attack in an update published in May 2023.

It acknowledged that a ‘small amount’ of HSE information was published to the dark web in the immediate aftermath of the attack, which has since been taken down, but maintains no further information was published in the years following the incident.

According to Lutrell, the attack was a turning point in terms of the nation’s view of cyber security, and thrust the topic into the public domain.

“The HSE cyber-attack was a landmark event of its type in Ireland. It had a widespread and direct impact on many Irish citizens with a significant degradation in healthcare service provision impacting hospital patients countrywide. It also brought the issue of cyber security into the public domain highlighting the risks and potentially devastating impact involved”, he explained.

“Many in the cyber industry felt this was inevitable following similar successful attacks to health services such as the NHS in the UK, however the full scale of the impact could not have been predicted and it highlighted a severe lack of cyber resilience.”

Lutrell said the fact this incident forced cyber security into mainstream debate was one positive result of the attack, and has resulted in pushing the government to take action and invest in cyber resilience across the country.

“A positive outcome of the very public nature of this attack was that it spurred the Irish Government into action to address some long-standing issues including under funding for the Irish National Cyber Security Center (NCSC),” he said.

“This agency has been significantly strengthened and expanded in the intervening years with the long vacant post of Director and a fit for purpose independent facility being addressed.”

As ideologically motivated attacks become more common, protecting public bodies is critical, Lutrell argued, pointing to another incident affecting a leading research institution in the region.

“Since the landmark HSE attack we’ve also seen a crippling ransomware attack at Munster Technological University, an institution that is regarded as a proven leader in the delivery of cybersecurity educational programs.”

“This example demonstrates the challenges in protecting large public intuitions and the direct impact to citizens. It is vital that public bodies in Ireland invest in effective cyber reliance programs with a focus on the ability to detect and respond to cyber threats in real time, 24x7x365.”

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