Taoiseach Enda Kenny has backed the Minister for Health’s warning that a high-level public servant will have to be sacked “for accountability” if the hospital trolley crisis is not fixed.

Leo Varadkar issued the warning in an internal email sent three weeks ago.

Mr Kenny said in the Dáil on Tuesday it was realistic to expect from any minister for health there was not an endless pit of money from taxpayers to deal with any situation.

“With an overrun every year for the past 30 years, perhaps it is time the Minister signals he is going to require accountability and responsibility be accepted by those who are in those positions,” he said.

The Taoiseach said the Minister was warning he was not content to have a situation where, year-after-year, a budget was agreed but never met.

“What I see here, for the first time, is a minister for health saying ‘we have got to have accountability for taxpayers’ money and the services we run here’,” he said.

Mr Varadkar, said Mr Kenny, was saying he was not happy with the way things were being run and that he needed people to step up the mark and take responsibility.

Fianna Fáil leader Micheál Martin said accountability should lie with the Minister whom he claimed was seeking the heads of those whose advice he consistently ignored.

“Waiting lists have gone through the roof, Taoiseach,” Mr Martin said. “Waiting times, patients on trolleys, 400,000 on the outpatient list now....”

Mr Martin suggested what was now being witnessed was “appalling cynicism” from the Government and Mr Varadkar on his stewardship on health in the lead-up to a general election campaign.