John Paul Phelan (Fine Gael)

I object to listening to someone in this House, or even in my office for that matter, giving a reading. This is a Chamber for debate, not for reading. Senator Minihan could make a contribution with the benefit of a few notes, to which we all have to refer from time to time, but he should not read everything he says.

The only thing the Senator did not read was his personal attack on Senator Browne. He opened his remarks by saying the debate should not involve personal abuse of the Tánaiste and Minister for Health and Children and I agree. Nobody said anything abusive about the Minister. There are many things for which I could reproach the Minister but I have no intention of being personally abusive towards her. Senator Minihan's contribution, from start to finish, was to personally abuse the leader of my party, Deputy Twomey and Dr. Bill Tormey at every opportunity. This debate is not a suitable occasion for him to launch into such personal attacks and he should apologise for some of the things he said.

Senator Minihan spoke about rehearsed outrage but he had rehearsed his speech and used a prepared script to give it. He also spoke about workable, costed and detailed solutions, of which he put forward none. Whether he likes them or not, Fine Gael came up with a number of workable solutions over the weekend. Other Senators on the Government side suggested solutions, as did Senator O'Toole and Senator Maurice Hayes. I am not an expert on health but I regularly meet people who work in the health services and others who seek to avail of them throughout the country and they have serious problems. The role of the Opposition is to ensure that those reservations and problems are raised in the Houses of Parliament and if Senator Minihan has a problem with that, he should not be here.

There is a crisis in hospital accident and emergency departments throughout the country. The Tánaiste acknowledged that after a year in office although we had been screaming about it for a great deal longer. She has endeavoured to make some positive moves towards resolving the problems.

A number of Senators made good contributions to this debate. Senator Henry was correct that the crisis in accident and emergency departments is but a symptom of other, deeper problems that exist in hospitals and in the health service. It is the most visible symptom. A number of proposals were made over the weekend which I will discuss in further detail. I disagree with Senator Feeney about the issue of drunks in hospitals. My second cousin, who is also a very good friend, is a nurse in St. Luke's Hospital in Kilkenny. He frequently works in the hospital's accident and emergency department and he has been assaulted on a number of occasions. This man plays hurling with the local team and is a couple of years younger than me. Accident and emergency staff are regularly assaulted.

People should take the time to read what Deputy Twomey said. He did not say that drunks should not be admitted to hospital but that they should be examined to ascertain if there is something more substantial wrong with them than just drunkenness. If not, they should be put into a wet room. That is the practice in many countries. The Fine Gael proposal is not about keeping them outside the door. Often these people are suffering from serious injuries of some type and need to be treated in hospital. However, in many cases they are not.

I have witnessed this. Approximately 18 months ago my father fell ill at home one Saturday evening. I brought him to Ardkeen, the regional hospital in Waterford. We waited for ten hours in the accident and emergency department for him to be seen. Eventually he was seen at 4 a.m. or 5 a.m. and I left. I witnessed the behaviour of some of the individuals there that night. My father is 80 years of age and he probably could have driven to the hospital himself but he could not have been left in the accident and emergency waiting room with some of the thugs that were there. There was nothing wrong with most of them.

I spoke to many of the staff and they told me they regularly confront this situation. It is all very well for us to pontificate and for people in the media to say, with lily livered liberalism, that these people might have serious problems but if they want to abuse themselves and get out of their tree with alcohol, they have a right to expect that people will examine them before admitting them to accident and emergency units. That is the correct approach. The staff who work in these units have a right to some type of protection when they do their work. Like other Senators, I applaud the people who work in accident and emergency facilities. They do great work.

Senator Minihan also referred to the Irish Nurses Organisation. He should not have done so. The Tánaiste decided not to attend the organisation's conference. I presume she had to attend another event. The INO made an important resolution at its conference. For the first time the organisation passed a vote of no confidence in the Minister for Health and Children. That organisation has had many rows with Ministers in this and previous Governments but this is the first time it went so far as to propose a vote of no confidence in a Minister. The Tánaiste has serious questions to answer with regard to her handling of the health portfolio.

I wish to mention the county hospital in County Kilkenny, St. Luke's. Fantastic people work in the hospital's departments but the accident and emergency facility in the hospital is antiquated beyond belief. I do not know how many years it has been that way. There are four or five cubicles in the unit. Of those, one was originally to function as a dedicated acute cubicle but it is operated as a general cubicle. Another cubicle occupies the space before the exit from the unit. The exit is obstructed by a trolley which acts as a cubicle for the unit. One cannot get through that exit in the event of an emergency. I saw this recently when I went on a tour of the hospital with the hospital's director.

Despite this, the people there do great work. The accident and emergency unit is quite successful in getting patients through the unit. It does not have major problems because the hospital also has a medical assessment unit. Senator Feeney and other Senators referred to these units in their comments. St. Luke's had the first such unit in the country. Dr. Courtney was instrumental in setting it up, despite strong opposition from some members of the old South Eastern Health Board. Eventually, a few million euro were provided and the unit has been most successful for St. Luke's.

The Tánaiste has spoken about establishing such units throughout the country but it has not happened in most hospitals. Establishing medical assessment units is one way of alleviating the difficulties in accident and emergency departments. These units assess people who are neither accident nor emergency patients and determine whether they need to be admitted to hospital. Setting up these units is a positive proposal.

Critical care units were mentioned during the debate. This is something new and I had not heard about it until the proposal was announced by Deputy Kenny last Friday night. I welcome it. It could be useful in this city, where the problem is most acute, and in large towns throughout the country that do not have accident and emergency units. The national health screening strategy announced by Deputy Twomey was a very positive proposal which is eminently workable. Elements of it have been rolled out already but if it were implemented across the country for different illnesses it would work well.

It is clear that we must provide, and soon, additional step-down beds. Senator Henry also mentioned this. The Government says it is in the process of tackling this issue but it has not yet delivered. Another promise that has not been delivered is the provision of doctor only medical cards. It is over a year since their introduction was announced but only 20,000 have been issued although it was projected that there would be a total of 200,000. If they were available fewer people would be presenting at accident and emergency departments. The Tánaiste and the Government have dragged their heels on this. That is a legitimate criticism. I ask the Minister of State to ensure that something is done about it.

I agree with Senator O'Toole's comments about the consultants' contract. The contracts that exist must be honoured. However, it is also clear that a new contract is needed for the people taking up consultancy positions. Whatever format that takes and whether more money must be offered, a resolution to the problem must be found as soon as possible.

The crisis in accident and emergency departments is probably more acute in Dublin than in other parts of the country but there are problems in many of the big regional hospitals. This should not become a vehement political issue but, as an Opposition, we have a role in pointing out the difficulties that exist and the problems people encounter. I will not be silenced by outbursts such as Senator Minihan's today. I will use every opportunity I have in this House and elsewhere to make my opinion on this and other issues known.