Since his appointment, the Minister for Health, Simon Harris has promised a number of times to enforce measures that would make health managers accountable for their actions.
It's not a unique statement for Health Ministes to make and neither is it uncommon that it is not accompanied by any kind of action.
For as Minister Harris' predecessor, Leo Varadkar conceded he had no power to remove staff, in the wake of the then overcrowding crisis.
The reality is that there is little the Minister or anyone else can do to punish under performance in the health service, just as there is little that can be done to discipline managers when serious incidents do occur.
Instead a system of veritable musical chairs pertains, which involves the moving around of managers who have come under fire publicly.
It's not the same with the frontline staff of doctors, nurses and midwives who are subject to professional disciplinarly processes, and often in public.
The seeming disconnect that exists between health management and what takes place at ground level can be seen in the team building trip that the HSE communications team took on the day that the hospital waiting list scandal emerged.
This was last Monday week, when a Prime Time special revealed the number of patients waiting for medical procedures was much higher than those on official lists.
Some 49,000 were found to be on separate lists, not released by the National Treatment Purchase Fund.
In total, some 623,185 public patients were on some form of waiting list for hospital care.
This information came to light on the day the HSE communications team was at the Barretstown campus for a team building event, which included a two course dinner and meal, and outdoor exercise.
Such is the scale of the waiting list crisis that people are now increasingly funding the procedures themselves, whether its getting loans from financial institutions, or from family members.
The figure now is that up to ten per cent of procedures are self funded by people on waiting lists who do not have health insurance.
This waiting list and trolley overcrowding crisis is being fuelled by the shortages in front line staff.
Around 1,500 nursing posts are currently vacant, a situation which has led nurses to threaten industrial action, from next month.
The health crisis is being stymied by a lack of funding and by its own structures, which sees a top heavy level of management.
The need to transform the service is there, but it is not accompanied by any will at present.
The factors outlined above are some of the ingredients which are making for a dysfunctional system, one which is ill equipped to meet the needs of an ageing population.
A system where access is based on need, rather than the ability to pay is still some way off.
The waiting list crisis is a scandal. This is a relatively small country, with a population to match.
We simply can't tolerate a system where people cannot get timely access to the service and care they need.
A system with Kafkaesque management structures, and too little in the way of frontline staff is a poor fit for the needs of the people it purports to serve.