Hospitals which eliminate the practice of patients waiting on trolleys and which make substantial progress towards fully assessing patients in A&E within six hours are to be offered access to additional consultant posts. Martin Wall reports
In a new incentive programme to be announced this week, the Health Service Executive (HSE) will offer to fund up to 100 additional consultant posts as a reward for hospitals with "high-performing" A&E departments. To qualify for the additional posts, hospitals will have to meet minimum conditions for patients attending A&E units and will have to substantially reach new "exceptional performance" targets to be put in place for winter.
These include the requirement that no A&E patient will have to wait more than 24 hours for a bed. The plan will stipulate that 75 per cent of such patients should have to wait no more than six hours.
Under the basic criteria for the scheme, hospitals will not be allowed to have patients waiting on trolleys for admission. Patients requiring admission will have to be accommodated in beds "in acceptable surroundings", such as in proposed admission lounges.
Hospitals will also have to ensure that elective or non-urgent cases account for at least 20 per cent of all admissions.
Under the new exceptional performance targets, A&E patients will have to be assessed completely within six hours. Hospitals will also have to reduce waiting times for outpatient appointments to a maximum of nine months and automatically have to refer everyone waiting more than three months for procedures to the National Treatment Purchase Fund (NTPF).
The fund claimed in June that several hospitals were not referring as many patients to it as they could.
Under the scheme, hospitals would also have to ensure that elective cases accounted for 25 per cent of admissions. The rate of cancellation for such patients could run no higher than 5 per cent. They will have to meet the basic criteria and have substantially reached the exceptional targets over the coming winter before they will be considered eligible for the new funding.
The HSE believes that large hospitals with about 400 beds which consistently achieve the new targets, could receive up to seven additional consultant posts, which would be in addition to those in the normal hospital development programme.
Informed sources said that the aim of the scheme was not to help hospitals to tackle A&E problems but rather to reward those which had already made significant progress in this area.
Targets and incentives/penalty clauses are becoming an increasingly common feature in hospital funding. The HSE has already withheld 2 per cent of the budgets of some hospitals pending the achievement of existing targets in A&E.
The new objectives and in particular the exceptional performance targets in relation to maximum assessment times, out-patients and NTPF referrals represent a major advance in this process.