Brian Lenihan Jnr (Dublin West, Fianna Fail)

Senator O'Toole uttered words that characterised the spirit of the debate when he said that political blame cannot be attached to the position obtaining in accident and emergency departments. However, this does not mean that political responsibility should not be taken and exercised. If one point has been made loud and clear by this debate, it is that the conditions prevailing in our accident and emergency units in public hospitals are a reflection of the underlying condition of our health service. If there are difficulties, they stem from a varied number of causes, which must be addressed.

The figure of 1.2 million persons attending accident and emergency departments on a national basis mentioned by Senator Moylan, an average of nearly 3,300 per day, is worth reflecting on. When opening the debate, I pointed out that 75% of these patients are treated and discharged without the need for admission to acute hospital beds. This is a tremendous record of service and delivery by all of the health service professionals involved, of whom Senators were unanimous in their praise. By and large, Senators also took the view that difficulties must be addressed and suggested various remedies.

The matter of step-down beds was raised. Clearly, if one wants to improve conditions in accident and emergency units, which are frontline posts in the public hospital service, one must examine the issue in terms of how people enter the units, how they are cared for therein and how they can be discharged if they require further treatment in the public hospital system. These are the different elements that must be tackled if one wants to get the accident and emergency unit situation right.

A number of Senators touched upon the fact that everything we can do to develop our community services, such as doctor and primary care services, is essential. The HSE has been insistent on this point. If one does not build up one's primary services and have them as the first line of defence there will be a crisis in accident and emergency units. For this reason, the Tánaiste has attached much importance to primary care and its improvement. She is anxious to make an announcement in this regard and have a roll-out in north County Dublin this summer, for example.

We must ensure that patients' first port of call is a general medical service, a service that is readily accessible to them. There are new models of primary care provision. Some have been developed on a public basis while others have been developed on a private basis. Not only do they bring together the general practitioner side of medicine, they also bring together other frontline disciplines involved in the patient's primary care in the community. The Government is committed to the development of these services, which is a vital need if we are to tackle problems in accident and emergency departments. We must examine how patients are cared for in these units and determine what initiatives can be taken to deal with minor injuries on a separate basis, including triage to ensure that patients are treated in as efficient a way as possible by the person who should be treating them, which was mentioned by numerous Senators. This is the second stage.

An element of controversy was introduced to this subject by the leader of the Fine Gael Party, Deputy Kenny's, suggestion in his presidential address to his party's Ard-Fheis at the weekend that some form of drunk tank should be constructed to accommodate persons who arrive at units in an inebriated or intoxicated condition. This point gave rise to substantial concerns that were referred to by Senators Daly, Moylan and others. I join with them and others who saluted the courage of the nursing and medical staff of accident and emergency units in the face of the physical threats they must endure. Senator Moylan outlined the steps that public hospitals have needed to take to install security cameras to survey the scene and provide a high degree of protection. It is a sad comment on the standard of behaviour that obtains in Ireland today.

To state the problem is not always to state the solution, which I accept we must find. I have taken an interest in this matter. The tank option as canvassed by Deputy Kenny is a non-runner. It may have generated some interesting headlines and public discussion but it is not an option. The ethics of the medical and nursing professions have always been clear — they will treat any patient who presents with physical or mental difficulties irrespective of his or her condition. One will not be able to persuade the professions to make a judgment about whether a person should be in a drunk tank or an accident and emergency unit. They will not make this distinction because it is against their ethical standards. They would not accept——