The chief executive of the Health Service Executive (HSE), Prof Brendan Drumm, yesterday rejected criticism of a reward scheme under which 100 additional consultants will be appointed to hospitals with high-performing A&E departments.
Prof Drumm rebuffed suggestions that it would make more sense to increase resources for hospitals failing to meet their targets, in order to help them improve their performance.
"The message across the system seems to be that resources only come when you actually have a crisis and that those who work extremely hard to ensure you don't have a crisis do not get any extra resources," he said. "We are determined to change that and this is the first major example of that."
Prof Drumm was speaking in Limerick, where he announced the first 60 new consultant positions under the scheme, which represents a €10 million investment.
He said it could take up to 18 months before the "full impact" of the new positions was felt, and added that the posts would not be advertised until the end of next month due to the ongoing consultant contract negotiations.
Prof Drumm described the scheme as "rewarding success". He cited the Mid-Western Regional Hospital in Limerick, where the average length of stay for general medicine is seven days, compared to up to 15 days in some other hospitals. It will receive 10 consultants under the new scheme.
When asked if it would not make more sense to award poorer-performing hospitals to help bring them up to scratch, he said "pouring resources into the system" was not the answer.
"Today is a starting point in recognising that, and I believe it's unique in an Irish healthcare set-up that we are actually recognising success in the system and actually rewarding success in terms of where processes have improved, and Limerick is an example of that," he said.
"It does not mean that other places are to be ignored. We are working very actively to ensure that all hospitals right across the country can reach this success in terms of treatment."
According to Prof Drumm, the problems in the healthcare system did not relate to getting into hospital, but "the major problem is actually getting out of hospitals". "We have average length of stays where people remain in hospitals for inordinate lengths of times compared to directly comparable countries," he said. "Even within our own Irish system, we have situations whereby people can remain in six days following an appendix removal, whereas elsewhere in the Irish system you only remain three days.
"If we were to actually achieve the lengths of stay in hospital . . . that are achieved in countries like Holland and Australia, we would tomorrow actually have created 1,200 new beds in the system - that's like two large hospitals."