Just who is in charge of hospitals in this health crisis?

The health minister wants heads on plates over the emergency department crisis, but the labyrinthine management structures in the health services may make his targets hard to choose. Caroline O’Doherty tries to untangle a very messy bureaucratic web.

Health Minister Simon Harris has been engaging in some tough talking by ordering reviews of health managers’ performances and suggesting he might replace them with external experts to try to get to grips with the crisis in emergency departments, but what’s not clear is who he is talking about.

Pinning down who actually manages EDs and is, or should be, responsible for patient flows, resource allocation, long-term planning, and pressing the panic button when numbers become dangerously high, is tricky in a service that operates in a system governed by structures that at times look designed to obfuscate.