The Government has defeated in the Dail by 65 votes to 58 an Opposition motion deploring the Government's handling of the "appalling situation" in hospital accident and emergency departments.

The Minister for Health, Mr Martin, said key shortcomings in the rest of the health system often came together in casualty departments. "The fact that 70 per cent of all admissions now come through A&E departments is the most dramatic demonstration that major investment and reform is required."

A single initiative would not deal with these issues. "A series of inter-relating initiatives are required, together with a sustained period of investment. That is what we are delivering."

Labour's health spokeswoman, Ms Liz McManus, who introduced the motion, said the crisishad deepened in the last five years. It was clear the Taoiseach's priorities were elsewhere. Money had been dedicated to reduce waiting lists which were as long as ever. "We have to ask why, after five years of economic buoyancy in which health spending doubled, people are still forced to wait, often in pain and distress, in A&E departments before they can see a doctor."

Mr Gay Mitchell, Fine Gael's health spokesman, accused Mr Martin of having the "brass neck" to establish 104 review groups but "not make any decisions".

Mr Michael Ring (FG, Mayo) claimed the Government had spent €300 million on PR over its period in office and had 85 "spin doctors". He "wouldn't mind if they were medical doctors".

Mr Martin said the health service would be much more developed "if we had not been required to make up for the lack of funding and planning which we inherited". More than 700 of 3,000 promised additional beds would be in place by the end of the year and this would result in a significant improvement in A&E services.