Minister for Health Leo Varadkar has signed an escalation order to help deal with emergency department overcrowding.

It removes the discretion of hospitals to invoke their escalation plan, if they breach certain overcrowding levels.

It means that if a hospital has patients waiting over nine hours on a trolley, or they breach other limits three times in a day, they must take certain measures.

They must initiate extra ward rounds to facilitate discharges and liaise closely with the ambulance service.

As a last resort, more beds must be opened on wards, or more patients moved from the emergency department to wards.

Mr Varadkar said: "The most recent numbers from the INMO and SDU indicate that the number of people on trolleys is lower for November 2015 than November 2014.

"This represents a marked improvement from the summer when the situation was between 20% and 40% worse than summer 2014.

"On any given weekday, the number of patients on trolleys peaks around 300, falling to 150 by the evening.

"While not acceptable, this is a far cry from the 500-600 we witnessed in January. The situation has eased due to the measures taken to date including increased staffing, more beds in hospitals, nursing homes and community facilities, more home helps and home are packages to facilitate discharge, and more community intervention teams, day hospital capacity and acute medical assessment units, to allow people to avoid having to go to the emergency department at all. Attendances are down about 1% this year.

"Nonetheless, there are still far too many people waiting too long in our emergency departments, so further measures now need to be taken to escalate this response to ensure that the progress is sustained.