Niall Hunter: Can we trust Mary Harney with the €1bn surgery on the HSE?
She can't be serious can she? The depressing fact is that as our country descends further and further into economic oblivion, Mary Harney is gearing us up for unprecedented health cutbacks.
Previously we were told that the cuts in 2011 would amount to around €600m.
Now the Health Minister tells us that they could amount to as much as €1bn.
The problem is that making savings in the HSE's budget next year will be like getting a camel through the eye of a needle.
Around 70pc of the health budget goes on pay.
For the moment, at least, there's a limit to what can be done with that because of the Croke Park deal.
The pay bill will be reduced to some extent as the staff moratorium which means that workers who leave cannot be replaced.
But the level of pay for remaining workers throughout the system cannot be cut.
This means that the Government and HSE's room for manoeuvre is mainly in the €5bn of health spending not accounted for by pay.
The big worry is that the cuts next year will be so drastic that frontline services will suffer to an even greater extent than they already have.
Can the HSE make savings without hitting frontline care?
Its record to date is not good.
We've already seen widespread bed closures, cuts in community care and staff shortages.
We can expect more of the same next year on top of likely increases in A&E and hospital charges along with reductions in State subsidies for drug costs and perhaps some other unwelcome surprises.
What we're least likely to see is the HSE getting rid of a large tranche of its permanent administrative staff, as it admits it needs to, in the absence of a voluntary redundancy scheme.
A major challenge for new CEO Cathal Magee as he tries to trim the HSE budget is that many services have already been cut back to the bone at a time when there is a rising demand for them.
Around 1,700 beds have been taken out of the system by closures and delayed discharges.
Admission rates to hospitals, especially emergency admissions, are rising. Inpatient waiting lists are on the rise again and there are countless thousands of people on outpatient waiting lists.
Many operations have been cancelled and people all over the country are experiencing difficulties in accessing many community services.
The reality is that there is still much waste in the system that can be trimmed.
The HSE could make much greater inroads into absenteeism levels, for example.
We could do without the kind of waste that means nearly €100m a year is spent on agency staff doing the work, at greater cost to the taxpayer, of staff that have gone and haven't been replaced.
There are plans to reform work practices and save money in areas like overtime, but it will be some time before that kicks in.
The big worry for all of us though the question of whether it is possibly to take so much out of an already flawed health system without permanently damaging it.
Niall Hunter is Editor of irishhealth.com. Tallaght Hospital debate, Pages 42-43