Health Minister Leo Varadkar has warned that heads will roll if the hospital trolley crisis continues.
He has told senior health officials that a high-level public servant will have to be sacked if the problem is not fixed, to ensure accountability.
Mr Varadkar sent an internal email three weeks ago, in which he described the problem of people waiting on trolleys for admission as "worrying".
"I have no reason to believe it won't be worse than last year, and that really means a head or heads will have to roll," he said.
"The people or Dail or Taoiseach can take mine in the election or thereafter, but we'll need an official/executive head to roll before that or there is no accountability."
Mr Varadkar has previously promised cash to alleviate pressure on hospitals this winter, with funding available to open 300 beds.
"We need to sustain this into the challenging winter period and that is why additional funding of €18m has been provided for winter initiatives to increase the capacity in our acute hospitals during this period," he said.
Fianna Fail health spokesman Billy Kelleher raised questions about how the internal email was "provided to a national newspaper" and accused Mr Varadkar of a "heavy-handed PR strategy".
"No doubt people are expected to be impressed by the minister's candour and plain talking," he said, adding that Mr Varadkar "should have been on top of this (the trolley cri- sis) long before now".
Meanwhile, members of the Irish Nurses and Midwives Organisation (INMO) in the emergency department (ED) of St Vincent's University Hospital, Dublin, have been balloted on industrial action to highlight on-going overcrowding there. The results will be known this week.
A hospital spokesman said nursing staff in the ED are supported by their colleagues throughout the hospital in the delivery of patient care.
He added that "incredible effort is made by all staff within the hospital to provide the best quality care to our patients".