Some 24 hospitals which have fared well in meeting targets for reduced waiting times for patients in A&E, have been rewarded with a promise of extra consultant staff.
The hospitals were told by the Health Service Executive (HSE) yesterday that they will, between them, get 60 extra consultants in a range of specialties including emergency medicine, radiology, general medicine, general surgery and geriatric medicine.
Critics of the move, however, argued that hospitals excluded from the scheme were being unfairly penalised for problems which were outside their control.
It is likely to be some time before the appointments, costing around €10 million, are made as the negotiations of a new contract for consultants, which have been long and drawn out, still have to conclude.
Many of the hospitals rewarded by the HSE yesterday traditionally have had few people waiting in A&E and include the Mid Western Regional Hospital in Limerick, which has been awarded the largest number of consultant posts, eight in all.
Others rewarded include Dublin's St James's and St Vincent's hospitals which are each due to get six new consultants.
However some hospitals which have been struggling to cope with overcrowding in A&E, such as Beaumont and the Mater in Dublin, got none. Neither did any of the hospitals in the northeast region and there are frequently large numbers of patients on trolleys at Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital.
Not surprisingly, a number of the hospitals which went unrewarded were among those named in the HSE's own A&E taskforce report published in June as unfit for their role. The new posts were handed out under the HSE's so-called "100 Plus" plan devised last year to reward hospitals with high-performing emergency departments. The hospitals which lost out in this round of appointments could succeed in the next round, the HSE said.
It is expected the remaining 40 posts to be created under the scheme will be determined by the end of October.
Dr Aidan Gleeson, an A&E consultant at Beaumont, said the end result of the HSE's initiative was that the A&E problem in hospitals such as Beaumont and the Mater would continue. He said these hospitals needed additional funding to help them meet national targets.
He said a major issue for these hospitals was the lack of long-stay beds to which patients could be discharged in north Dublin, and this impacted on waiting times in A&E. "We are not in a position with the resources we have, to have no patients on trolleys waiting for beds," he said.
"I think a carrot and stick approach is a good one . . . but what we seem to have is a stick approach without the carrot.
"This does not help morale among the staff. It's being insinuated that people are not doing their job well enough and when they pull their socks up they might get a few carrots," he added.
Dr Illona Duffy, a GP in the northeast, said the scheme was unfair and she urged the HSE to reconsider it. She said hospitals in Cavan and Drogheda had to take on extra work from other hospitals in the northeast without extra staff or space.
Dr Fergal Hickey, president of the Irish Association of Emergency Medicine, said 12 of the new consultants would be in emergency medicine. They were welcome as there had been no new A&E consultant posts approved for three years, he said.
Labour's health spokeswoman Liz McManus said it was essential patients attending hospitals not getting new posts were not further disadvantaged by the HSE's announcement.
Irish Hospital Consultants Association secretary general Finbarr Fitzpatrick welcomed the extra consultant posts but pointed out that some hospitals did not have the physical resources to meet the targets set by the HSE. "These hospitals are fighting with one hand behind their backs," he said.