Varadkar warns head will roll if new plan on overcrowding does not succeed

Minister for Health Leo Varadkar has warned health officials that "heads will roll" if the latest initiative to address hospital overcrowding does not succeed.

He told senior hospital and HSE managers the taxpayer has “a legitimate expectation that they will see tangible results for the additional sums being provided”.

In comments to members of the implementation group of the emergency department taskforce report, Mr Varadkar is underdstood to have criticised discrepancies between previous presentations he had received indicating the progress was being made and information which was given to him on what was actually happening on the ground.

Sources suggested Mr Varadkar did not single out anyone in particular for criticism but said that while it was his responsibility to fight for resources at Government level, it was up to people such as senior managers, medical directors and directors of nursing to make progress by acquiring beds, sheets and curtains and recruiting the staff needed.

It is understood the Minister said a lack of progress would undermine his case for more resources from Government as well as the efforts of everyone involved in the health sector.

Sources said he told the meeting that if 600 or 700 people ended up on trollies in the New Year, they all would be collectively “in the dock for it”.

Mr Varadkar is said to have inisted that the Minister, department officials, HSE executives, group managers, clinical directors and union and patient representatives would face either a collective solution or a collective failure.

Speaking after the meeting, the Minster announced more than 300 new hospital beds would be opened before the end of the year to help tackle the overcrowding crisis.

Mr Varadkar said changes in the way hospital consultants worked would also be sought in order to achieve greater patient throughput. The aim was to see more seven-day working by doctors with greater responsibility for discharging patients being assigned to nurses, he said.

While the vast majority of consultants were “very stretched” there was evidence of weekend working not happening in some hospitals and of patients not being discharged over weekends.

The Minister said he was satisfied with the progress made in reducing overcrowding, following the allocation of €74 million in extra funding this year, but insisted more needed to be done.

Numbers awaiting admission from emergency departments were up 40 per cent in August on the same month in 2014.

Medical organisations criticised the Minister’s comments on consultants’ work practices.

Dr Peadar Gilligan, chair of the IMO's consultant committee, maintained that under a 2012 work practice agreement, all consultants could be rostered for a 5/7 service to include weekends while in addition a deal was reached between the IMO and the HSE in relation to delegated discharge ( to nurses) so as to allow patients to be discharged over the weekends.

Dr Gilligan said it was not the case that consultants needed to change their work practices. He saidthe problem was that there were not enough consultants to allow for an ongoing 24/7 consultant -delivered service .

“The Minister has said that money and staff will not solve the ED crisis but that is simply not correct.”

Dr Gerard Crotty, president of the Irish Hospital Consultants Association said: "Acute hospitals do not have sufficient resources to provide a 7- day a week service. Despite this, consultants currently provide 24/7 on-call care and treat patients in hospitals over the weekends."

“As a result of the medical brain drain, consultants are extremely overstretched with acute hospitals having far too few consultants to provide high quality safe care to patients. This has been exacerbated by over 230 permanent hospital consultant posts not being filled currently.”