Some €32 million in funding due to be given to hospitals in the second half of this year will not be issued unless hospitals reach certain targets for waiting times in their accident and emergency (A&E) units.
The plan, announced yesterday by the Health Service Executive (HSE), will see 2 per cent of the annual budgets of 35 hospitals with A&E units linked to them taking steps to solve overcrowding in their A&E departments.
John O'Brien, head of the HSE's national hospitals office, insisted the money was being used to incentivise hospitals to take action to reduce waiting times for patients in A&E rather than to penalise them.
Also yesterday, the HSE said it expected an out-of-hours general practitioners co-op to finally come into operation in north Dublin in September. However, talks between the HSE and GPs on setting up the co-op, which broke down earlier this year but reconvened in recent weeks, have not yet concluded.
The negotiations, facilitated by the Irish Medical Organisation, have made considerable progress to date, the HSE said, adding that it was "anticipated that a successful conclusion will be arrived at in the next few weeks". The HSE hopes the co-op, if and when it is established, will result in fewer patients turning up at hospital A&E units in the area.
Meanwhile, the HSE said hospitals will have to ensure in coming weeks that no patients spend more than 24 hours in A&E once a decision to admit them has been made. Later this year, the target will be that no patient has to wait more than 12 hours. Next year, the target will be six hours.
Angela Fitzgerald, chair of the HSE's A&E taskforce, said the HSE was working with individual hospitals to help them achieve these targets. She said one of the major issues for Dublin hospitals was delayed discharges and, in hospitals outside Dublin, access to diagnostics at community level would be important.
Ms Fitzgerald said the 2 per cent of hospital funding linked to A&E targets would be "unlocked" as the targets were met. If the measure was meant to be punitive, the amount of funding linked would have been much greater, she added.
However, unions representing doctors and nurses have expressed reservations about the plan. Liam Doran, general secretary of the Irish Nurses Organisation (INO), said: "The only losers in a hospital's budget being cut are patients ultimately."
He added that the INO would be seeking more details of the proposal at the next meeting of the A&E forum.
Finbar Fitzpatrick, secretary general of the Irish Hospital Consultants Association (IHCA), said what the HSE was proposing was to penalise hospitals financially for the fact that they didn't have enough beds to admit patients from A&E. "It's financial blackmail . . . patients will suffer as a result of this proposal," he said.
"There is a danger pressure will be brought on consultants to discharge inpatients prematurely to make way for patients on trolleys," he added.
A delegation from the IHCA is due to meet Minister for Health Mary Harney today to discuss the A&E crisis, as well as the stalled consultant contract negotiations.
Meanwhile, the HSE also announced yesterday that it will, from now on, publish details on its website every day of the length of time patients have to wait in A&E units across the State before being admitted to a bed. Its figures show there were 26 patients waiting more than 24 hours for a bed in A&E units on Wednesday.
These included nine patients at Mayo General Hospital, eight patients at Letterkenny, four patients at Tallaght, three patients at the Mater, and one patient in both St Vincent's Hospital, Dublin, and Our Lady of Lourdes Hospital, Drogheda.