The welcome increase in funding since 1997 has shown clearly how ineffective are the management structures and accountability of the health service. In previous years, when resources were not so available, we could have argued that the problem was lack of resources but that argument is now hollow. Clearly, the problem is not resources but rather how these public resources are planned, managed and accounted for. Is the €9 billion spend delivering everything we can expect it to? Do the 100,000 who work in the health service use their talents effectively and are they well-managed and focused on service delivery? Is there clear and accurate public accountability for this level of public resources? Fundamentally, does the system work? Clearly, the answer is "No". It neither works as we expect it to nor as the public deserves.