The warning in the letter from the chief executives of four major hospitals to the HSE that relentless health cutbacks are threatening patient safety and service quality essentially delivers one very unpalatable message for Health Minister James Reilly.
The message is that the game is up. The public will no longer tolerate bluster and spin when it comes to funding and planning our health services.
Any Health Minister who continues to try to put a brave face on things and indulge in rhetoric rather than action while Ozymandias-like, nothing else remains, should consider his position.
No longer can the Minister credibly speak of 'delivering more services with fewer resources.'
Those running our major hospitals now say this essentially means delivering a less safe and less efficient service.
No longer can the Minister speak of 'challenges' involved in providing a modern health service with an ever -reducing budget.
The hospital chiefs have indicated that this is no longer a 'challenge'- it is an impossible task.
No longer can the Minister talk credibly about reform and 'money following the patient' when there is little money to do any meaningful following.
And the Minister cannot claim that the funding crisis is a HSE issue when it is his Department that is directly running the HSE.
The protestations of frontline workers that safety is being compromised can no longer be dismissed as vested interest grumbling.
Those at the top of the hospital management pyramid have come down from the mountain peak and taken a long hard look at what's happening, They see an 'appalling vista'.
Prior to the Budget, there was some hope that after a 20% plus cut in health funding in recent years, and with the country beginning to wake up from an economic nightmare, health services might be spared major cuts next year.
The spin was that there were plans for free GP care, the 'greenshoots' of health service recovery may be starting and next year's cuts mightn't be too bad after all.
But no, it was to be more of the same. The cuts were to be of the order of €666 million or perhaps even more. This was after over €700 million in cuts in 2013.
The health service, thanks largely to unreasonable Troika diktats but also due to the failure of the Government to deal realistically with the issue, has taken a disproportionate share of pain during the austerity era.
Hospitals year on year have been dealing with increased demands from an ageing and poorer population with diminishing resources. They were expected to deal with this while having their funding cut by one-fifth since 2009.
Some have been running up major 'historic deficits' from year to year and, like the HSE as a whole, have had to be bailed out by the Department of Health.
We now know what this impossible juggling act actually means - delays in treatment for cancer patients, still overcrowded emergency departments, trolleys on hospital wards, poor infection control measures, and a failure to keep waiting lists in check.
In recent months, the HSE, in its performance reports, has been pointing out that services are being delivered (or not as the case may be) against a background of a €3.3 billion cut in the health service budget since 2008 and the loss of over 12,000 staff.
By the time the €666 million plus cuts are implemented next year, the health service will be managing on €4 billion less per year than was the case before the 'age of austerity' descended. Oh, and with 2,600 more staff taken from the system by the end of 2014.
The hospital chief executives are right - this is no longer sustainable.
The HSE's service plan is expected to be published next week. The Government needs to finally deal with the lack of equity in health service funding. It must ensure that this is a service plan that can actually be delivered upon, and not a work of fiction.
While his handling of various health service crisis issues has been poor overall, the funding crisis cannot be laid solely at the door of Minister Reilly, as it is ultimately a Government issue.
However, any health minister who is seriously expected to continue to stand over over a system where continuing cuts are putting patients' lives and health at risk surely must consider his position as a matter of principle. Especially as he is a doctor as well as a (not always very skilful) politician.
For slow learners, the dictionary definition of principle is: "A fundamental truth that serves as the foundation for a system of belief or behaviour or for a chain of reasoning."
There is only so much people using our health service can take. Surely this also applies to the Health Minister.
Hospitals say cuts threaten patients