Can the HSE fulfil its remit and overcome the medical and local politics that have been hampering our health service, asks Martin Wall.
At a meeting later this month the board of Our Lady's Hospital in Crumlin will again consider the issue of controversial plans for a new national children's hospital on the site of the Mater on Dublin's northside.
The meeting was deferred from next week to allow the chairman of Our Lady's, the Archbishop of Dublin, Dr Diarmuid Martin, to attend. The archbishop was not at the controversial meeting of the board two weeks ago, when it decided not to co-operate with the development of the new facility at the Mater.
Dr Martin has indicated his unhappiness that he was not informed in advance about the proposal to opt out of the project and has called for more dialogue.
The Government will now be waiting anxiously to see whether the presence of Dr Martin, as well as various behind-the-scenes contacts that have been underway between health service management and hospital figures, will lead to the Crumlin board softening its stance.
It is understood that the Department of Health and the HSE are hoping to persuade the board to at least take part in the current design and planning process for the new hospital, even if it reserves its position on fully participating in the move to the Mater site.
Consultants RKW have been given 10 weeks to produce a framework brief for the new hospital. In addition to the hospital itself, their report will also look at the number of satellite "ambulatory care" centres for children to be developed elsewhere in the city.
These centres could provide emergency care, out-patient clinics, day surgery and even some forms of cancer care and, by their nature, are likely to have to be based in other hospitals rather than in the community.
Highly-placed health service sources said this week that some of the concerns raised by Crumlin about the Mater site - such as accommodation for parents, the availability of single rooms and play areas and questions of light and space - are among those that RKW has already been asked to address in its report.
However, given the passion that the current debate has raised, there is no guarantee that any meeting of minds can be achieved.
The events of the last few days have been extraordinary, even by the standards of the health service in Ireland in recent years, where controversy has never been far from the surface.
The rows have revealed the reality that, despite the establishment of a monolithic HSE to run all services and the availability of previously undreamed of resources, the traditional fault lines of Irish healthcare - the medical and local politics, the institutional rivalries, the turf wars, the disagreements over philosophies of care and the involvement of religion - have never gone away.
For the Government, and indeed for patients and their families, there are high stakes at play in this controversy.
The configuration of hospital services in Ireland has always been a hugely political issue. However the establishment of the HSE was supposed to get away from the local politics that hamstrung reform in the past and allow controversial, but necessary, decisions to be made in a dispassionate way.
The location of the new children's hospital is the first test of this new system. If the message gets out that such "final" decisions can be reviewed afresh if further objections are raised or through political or medical lobbying, what are the prospects for the HSE delivering on other contentious issues in the future?
And within months there will be other decisions that have the potential to be equally controversial, such as the location of the new hospital for the northeast and the new centralised cancer regional structures.
For the HSE and the Department of Health, this also raises questions about how the process aimed at delivering a €500 million project was handled.
Much media energy this week has been devoted to the worldwide hunt for the international paediatric experts who advised the task force that chose the Mater site. These experts have said they never recommended a particular location for the hospital, while the HSE has pointed out that this was never the intention.
The HSE has argued that the international experts were only asked for advice on clinical issues.
However, critics have maintained that a clear impression was given last year that the decision to opt for the Mater followed "extensive consultation" with experts abroad.
Given the level of controversy involved, and the potential for critics of whatever decision is taken to exploit any opportunity to have it reviewed, surely the task force report should have spelled out precisely the role of the international advisers and who had made the final decision on the site?
The Government has said it is determined that the project should go ahead. The HSE is considering plans to contractually oblige new staff appointed to the existing three paediatric hospitals in Dublin to transfer to the Mater site.
However, with most Opposition parties seeking a review, and a general election approaching, there remains some uncertainty about the project.
And as we have seen in recent years, health service rows, changes of mind and uncertainty on the part of Government can impact upon patients.
Disagreements over the structure of Tallaght Hospital were partly responsible for holding up that project for many years. Also, the plan to develop a local children's hospital on the Mater site - which was abandoned in favour of the new national children's hospital project - has led to delays in the redevelopment of the Mater Hospital itself.
All parties in the current dispute accept that existing facilities are inadequate and maintain that their particular approach is in the best interest of patients.
But very often patients are the people who lose out when doctors and administrators cannot agree.