Heads unlikely to roll any time soon, despite the dreadful scandals
Lack of accountability in the health service has been a constant refrain in the aftermath of scandals. Patients can suffer serious injury or die, but when it comes to administrators and management the old excuse of "systems failure" is usually a convenient safety net.
Back in 2015, former health minister Leo Varadkar spoke of "heads rolling" in an internal memo about overcrowding.
But later he admitted nobody could be sacked.
Poor management is also now being increasingly blamed for contributing to the ongoing trolley crisis and spiralling waiting lists.
The latest much-touted promises of a more rigorous performance and accountability regime for health managers, announced by the Health Minister Simon Harris, is a long and wieldy process.
And it is also without the ultimate sanction of dismissal or even a reduction in salary.
The final step says if the manager fails the various performance reviews they will be removed from their post and reassigned to other duties.
The Portlaoise Hospital scandal is a classic case of the HSE's failure to hold its staff to account, allowing for the need for due process.
It is almost two years since the HSE promised an investigation into whether staff should be disciplined, arising after the deaths of five babies in Portlaoise.
The promise was that it would be completed in three months.
However, it is unclear what has happened since. A spokesman for the Dublin Midlands Hospital Group, which includes Portlaoise Hospital, said last night the disciplinary process concerning issues at the hospital is "at an advanced stage".
But he could not say how many have appeared before a disciplinary body, if any.
Following a damning Hiqa report the HSE agreed to establish an investigation into staff performance and responsibility nearly two years ago.
It led to three retired NHS officials being hired to carry out the review and an initial examination said around 16 staff should have their role probed.
The process was supposed to have been concluded in the summer of 2015.
However, it faced a legal challenge from one member of staff and the review had to be reconstituted with a view to a completion at the end of 2015.
A barrister and a Northern Ireland obstetrician were also appointed.
The whole process has been beset by concerns of legal action.
At one point the HSE suggested it would be forced to set up a commission of investigation which would cost €10m in legal fees.
The entire debacle shows the obstacles in the way of securing accountability.
In the meantime the families whose children died in Portlaoise are still waiting for answers.
The Department of Health yesterday was unclear on the legal status of the performance and accountability framework for managers, which is being promoted by the minister as a way of shining a light on competence in handling struggling hospitals in particular.
The HSE could not say if it has been invoked although it has been in place since 2015 and was enhanced in 2016.
In the meantime, the public is right to remain sceptical.