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Tall order: Professor Drumm has his hands full in lifting the siege that has beset the HSE. Despite his considerable efforts much of his
time is still devoted to fire-fighting

Tall order: Professor Drumm has his hands full in lifting the siege that has beset the HSE. Despite his considerable efforts much of his time is still devoted to fire-fighting

Tall order: Professor Drumm has his hands full in lifting the siege that has beset the HSE. Despite his considerable efforts much of his time is still devoted to fire-fighting

Now that Mary Harney has dealt with political accountability, the HSE is preparing to take the hit for medical responsibility in the health service.

And as sure as Christmas is coming, shock and awe raining on the upper management structures of the HSE will be the first of the Government's New Year's resolutions.

Ministers and senior figures in the Department of Health believe that putting accountable management into the HSE will require fierce determination applied with micro-precision.

The fear is that, while senior figures in the management need amputating or moving, keeping Professor Brendan Drumm as head of the HSE is imperative.

The latest investigation into the scandalous chaos in the HSE is due to report in January and heads are expected to roll on foot of that report.

But the shame of Portlaoise has also left the HSE losing the trust of the people for whom it should provide a service to match its 130,000 employees and €13bn budget.

Although the Opposition did its constitutional duty in challenging the Dail's confidence in the Minister for Health, one local TD made an interesting observation.

Sean Fleming, the local Fianna Fail TD, said yesterday he didn't receive a single angry phone call about the breast cancer scandal in Portlaoise.

"I was inundated with calls when Noel Dempsey did his thing on the holders of provisional driving licences but not a single call about breast cancer diagnosis," said Fleming.

"People knew the driving licence business was a political c**k-up but they also knew the breast cancer scare was a medical problem."

Meanwhile, saving Professor Drumm, the head of the HSE, is just as important a priority as calling pay-back time on HSE managers.

This morning Professor Drumm was set to meet the Oireachtas Public Accounts Committee where he would have faced questioning about the apparently hapless HSE.

The meeting was rescheduled because of the sad death of his mother, but Professor Drumm's day of reckoning there has just been postponed, not cancelled.

An air of foreboding over senior HSE managers and officials has deepened in tandem with the public's confidence in their ability to deliver a credible health service.

When Bertie Ahern publicly named a senior official in connection with the scandal of women using breast cancer facilities in Portlaoise last weekend it was a sign that politicians intend redirecting blame to health managers.

Then Minister for Social and Family Affairs, Martin Cullen said the structure of the HSE should be re-examined.

Whatever shake-up comes, early signs are that, while Prof Drumm has many talents, in the minds of some, management is not his strongest suit.

And that the boss's office at the HSE will be beefed up, by bringing more experienced managers into his team.

It will take at least another two years to deliver the service he has promised and there are just another 30 months of his five-year contract to run.

Professor Drumm has a fine international reputation and his future depends on leaving a modernised health service behind when he has completed his tour of duty at the HSE.

Mary Harney recently closed down her constituency office; she will not run for the Dail at the next election and her legacy in public life will be determined by the state of the health service when she leaves it.

The HSE is the amalgam of 13 regional health boards that duplicated services -- while acting as an election agent for local politicians.

Clearly a single authority, where politicians could not use local interests to hamper a national service, was a no-brainer for the Government.

But there was also a suspicion that distancing the HSE from political influence meant that the Minister for Health was outsourcing any blame from her office to the HSE.

When they set up the HSE in 2005, not a job was lost bringing the 13 regional health boards into a single body, which may be a tribute to the negotiating power of public service unions but did serious harm to the health service.

Yet the HSE has had its successes too: last Thursday morning, Professor Drumm planned to tell the joint Oireachtas committee of health how it had saved €100m on medications; how it had planned the national centre for paediatric care; of an out-of-hours GP service in north Dublin; and of plans for a new hospital in the north-east.While he was delivering the HSE's good news, one of his officials matter-of-factly told the committee that the HSE was reviewing 568 breast ultrasounds carried out in Portlaoise hospital and that 97 women were being recalled.

It was the tipping point for the Government and why the HSE can expect heads to roll early in the New Year.