Put A&E action plan in place or be fined, says Varadkar
Hospitals where A&Es have reached a serious level of overcrowding will be forced to trigger an action plan to free up beds and divert emergency patients elsewhere.
A directive signed by Health Minister Leo Varadkar and the HSE yesterday makes it mandatory for hospitals to invoke this escalation plan when trolley waits and numbers have reached a certain level.
Until now, hospital managers could decide themselves if it should be called on, leading to criticism by nurses who claimed A&E overcrowding was allowed to worsen as services continued as normal.
The downside of these plans is that patients who might be ready to be admitted for an operation can have it cancelled to spare the bed, while ambulances may be asked to transfer patients to other hospitals which are also under pressure.
But Mr Varadkar said hospitals could be fined if they don't comply with his directive.
The move will be unpopular with doctors working in areas other than A&E who want their patients admitted, or may be reluctant to discharge someone they feel is not ready.
Mr Varadkar insisted the most recent figures indicate numbers on trollies are lower for November 2015 than November 2014.
"This represents a marked improvement from the summer when the situation was between 20pc and 40pc worse than summer 2014.
"On any given weekday, the number of patients on trollies peaks around 300, falling to 150 by the evening. While still not good enough, this is a far cry from the 500-600 we witnessed in January."
The situation has eased due to increased staffing, more beds, nursing homes and community facilities, more home helps and home-care packages to facilitate discharge, and more community intervention teams, he added. The escalation plan could also see hospital staff working with community intervention teams to provide antibiotics and other basic care in a patient's home or care facility, rather than a hospital.
"As a last resort, extra beds will be put on wards. A&E congestion is a key issue for the whole hospital, and for primary and community care services."
Some €117m of additional funding - specifically to address overcrowding - has been allocated.