Editorial: 'HSE needs drastic surgery - we can only hope for a cure'

They were repositories of political power and influence. Also thrown into the mix were more than 40 health agencies. Navigating or supervising such a labyrinth was near impossible.

Thus an amalgamation of roles in a single unified structure made absolute sense.

Thus the HSE was born. Yet today, despite a budget of around €17bn, it has acknowledged meeting future and immediate challenges is unsustainable. Many regard it as unfit for purpose with more than 100,000 staff.

Earlier this year at the launch of Sláintecare, Health Minister Simon Harris committed to "defining and agreeing a new organisational and operational structure for the future reconfigured health and social care service".

This would include changing the respective roles of the Department of Health, the HSE and regional and community organisations.

He would also "develop a roadmap and policy proposals." Decoding the gobbledegook, this amounts to dismantling the HSE.

But this must not mean reverting to a failed model. But that does not mean a complete reversal of Government policy - even after 14 years - would be so far-fetched.

The two critical problems identified are our hospitals are understaffed and there are not enough beds in the system - the very same problems the HSE was devised to overcome back in 2005. Such is the context in which a restructuring of the HSE will be announced this week.

What was intended to be an instrument of service has become an insatiable beast too bloated to move efficiently. It is also too top-heavy to rise to the challenges of an ageing population.

So will replacing it with six regional boards be the answer? This will depend on preventing political interference, protecting and managing budgets, and creating the right outcomes for patients. We have created a triple-canopy forest of red tape within the health service.

Resources are drained to back-office services instead of being diverted to the front line.

Jobs will have to be cut so systems can become more streamlined, manageable and more patient focused.

We have been promised several iterations of the HSE; yet the familiar crippling issues persist. According to Mr Harris: "Sláintecare will deliver a health and social care service that meets the needs of our population and attracts and retains the very best healthcare professionals."

We hope so. But experience gives little grounds for confidence. We have become too tolerant of the intolerable. Expenditure on health here is reasonable by OECD standards, so why is our health system in such a dire state?

The public will accept a partial return to the old health board system, but not to cronyism or a duplication of services.