Camillus Glynn (Fianna Fail)

Precisely. This is a problem and a debate for another day. Special training must be given to GPs, who have done a great job in the past in providing such services, and the appropriate insurance cover supplied. The MidDoc facility is an excellent service because it saves many visits to accident and emergency departments and ensures the patient receives prompt and adequate treatment and that the local GP has a quality of life which he or she did not heretofore enjoy.

The Tánaiste observed there are social reasons for delays in the discharge of hospital patients. I support her contention that follow-up services and support structures must be provided. Upsetting terminology has been used in respect of elderly patients availing of accident and emergency services. It is outrageous to describe those who have built this State and who are now in the winter of their years as "bed-blockers". Senator Browne referred to the special step-down unit for preparation for discharge in Kilcree, County Kilkenny. This is the way forward.

Members have referred to health and safety issues in accident and emergency departments. I was recently approached by a well-qualified health and safety officer who informed me there is a problem in this regard across the entire strata of working environments. There are people working as health and safety officers who do not have the appropriate training. This is a separate problem. Anyone with any knowledge of nursing and medicine is aware that the disposal of excreta is and always should be a nursing duty. Excreta must be disposed of in the proper way. If its disposal is the responsibility of those who are not aware of correct procedure there is a clear danger that highly infective organisms such as the MRSA bug may be transmitted to patients and cause the mayhem we have witnessed in our hospitals.

As a member of the Midland Health Board for many years, I am aware that accident and emergency consultants are employed in Tullamore and Mullingar hospitals and provide services in Portlaoise hospital. There is no doubt this has brought major improvements to patient services. However, one of the great abuses of accident and emergency facilities relates to the abuse of alcohol. Patients who are boozed up to the gills report to accident and emergency departments at night after being involved in an altercation with associates or as a consequence of an unprovoked attack arising from the abuse of alcohol. Such patients should be hit hard in the pocket because they cause mayhem not only in accident and emergency units but also in psychiatric hospitals.

The Tánaiste observed that in Leicester, a city of comparable size to Dublin in terms of population and in which I have worked on three different occasions, there is one accident and emergency facility. We clearly must focus on the use and possible abuse of our accident and emergency services. It is obvious there are people presenting in accident and emergency units who should be going elsewhere for treatment.

Significant resources have been invested in this area of the health service. In November 2004, for example, the Tánaiste announced additional funding of €70 million for current expenditure in 2005 to implement a number of initiatives to improve the delivery of emergency services. In addition, €10 million in capital funding has been provided in the context of the HSE's overall capital allocation. The plan to improve accident and emergency services includes the development and expansion of minor injury units, chest pain clinics and respiratory clinics to relieve pressure on hospitals' accident and emergency departments. Other developments are the provision of a second MRI scanner at Beaumont Hospital and the provision of acute medical units for non-surgical patients at Tallaght, St. Vincent's and Beaumont Hospitals.

In addition, there will be a transfer of 100 high-dependency patients to suitable private nursing home care and an active consideration of the scope for using greater numbers of private nursing home beds to alleviate pressure on acute hospitals. This is a sensible approach. Negotiations will take place with the private sector to meet the needs of 500 patients annually for intermediate care of up to six weeks. We must address the needs of elderly people awaiting discharge to nursing home care or their own homes with appropriate supports. Expanded home-care packages to support 500 additional older people at home will help in this regard.

A priority is the provision of more out-of-hours GP services in order to reduce people's need to attend accident and emergency units to a minimum. As I said, the MidDoc facility is providing a great service, especially in County Westmeath. Measures will be taken to ensure the efficiency of the dedicated cleaning service and security measures for accident and emergency departments. The further expansion of palliative care facilities and the proposed measures to enhance direct access for GPs to diagnostic services are extremely important.

The Department of Health and Children is liaising with the HSE to progress the implementation of the plan. New accident and emergency departments have been provided at Cork, James Connolly Hospital, Naas General Hospital, the South Tipperary General Hospital in Clonmel and Roscommon General Hospital. The accident and emergency unit at the Mater Hospital has also been refurbished. I could continue.

It is important to set up rapid access units. A model casualty unit was set up in Longford some time ago. "Casualty" is perhaps not the appropriate term today, but that unit has done tremendous things for the people of Longford. It has significantly reduced the number of people attending the accident and emergency unit in Mullingar. I acknowledge, however, that there is a situation that needs to be seriously addressed.

I remind Senator Browne that medical cards are an income-related facility. It has not been the practice to give people a medical card when they come into gainful employment. There have been people on the fringes, just outside the terms of qualification for medical cards, but that will be addressed through the doctor-only system, which has been an innovative proposal. I eagerly await——