Evelyn Joel ruling raises questions for the HSE

A decade after the events occurred, a Court of Appeal judge has delivered a harsh criticism of the actions, or inaction, of HSE and other public service officials involved in the case of Evelyn Joel.

Once again, the HSE stands in the firing line in a tragic case, this one centring on the death of Ms Joel in Co Wexford in 2006.

Mr Justice George Birmingham says the nature of the HSE's interaction with Ms Joel "gave rise to concern and disquiet".

He pointed out that during the first 10 months of her stay with her daughter Eleanor, Evelyn was seen 15 times by a public health nurse or one of her team.

Yet in the final four months, she was not visited by any nurse and, the judge said, the sole involvement of the HSE was limited to leaving nappies outside her house.

On a simple reading, the HSE would appear to have been neglectful in respect of the needs of Ms Joel, and staff could have done more to establish the full extent of her deterioration.

Yet evidence was given at the various trials generated by her death that officials were told Ms Joel was not at home, when in fact she was.

This begs the perennial questions for social care staff of how to get the balance right between intervention and non-intervention.

On many occasions in other controversial cases, staff have been criticised for being either too hands-off in their approach or too heavy-handed.

It is a difficult balance to achieve, but add to this the under-resourced nature of social care in Ireland and the ubiquitous issues around understaffing and it becomes even more difficult.

Nearly every party campaigning in the recent general election called for a greater emphasis on primary care services but the reality at present is that these exist in only skeletal form throughout much of the country.

Further, there is plenty of evidence to show that the different elements of the system are not communicating as well as they might to ensure that problems are escalated early enough.

“Damned if I do, and damned if I don’t,” sums up the response of many healthcare professionals when controversies arises and, while circumstances vary from case to case, there is often an element of truth in this response.

Public health nurses

Public health nurses work from local health centres and provide a range of services to medical card holders, such as post-hospital care, dressings and injections.

Another major role, though unspoken, is to act as the eyes and ears of the health system for issues that may arise.

While the service works well in the case of newborns, a lack of resources means services for adults are stretched nearly everywhere.

This is not to excuse the inadequacies referred to by Mr Justice Birmingham, but further inquiry would be needed to establish the context in which these occurred. At this stage, it is hard to see what this could, or would, achieve.