Maternity Services (Morecambe Bay)

Sarah Wollaston Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Mr Hunt]

I think we can trust the CQC’s view that the care in the maternity unit is safe, but the hon. Gentleman is absolutely right to draw attention to the issue of the barriers between doctors and midwives, which is striking. That goes back a very long time: there seemed to be a kind of macho culture among the midwives to do with not letting the doctors in, which probably led to babies needlessly dying, which is the great tragedy. Making sure that that culture is changed, so that the patient’s needs are always put first, is obviously a massive priority. I know that the trust has made great strides in that area, but we all understand too that it takes time to change culture, and we need to support it as it goes on that journey.

[Dr Sarah Wollaston (Totnes) (Con)]

I join the Secretary of State in paying tribute to James Titcombe and all the families who have fought so long for answers. I also thank Dr Kirkup for his excellent report. I welcome the action that the Secretary of State has announced today, but can he add to that list by saying whether we can bring forward having medical examiners to look into the cause of death before the end of this Parliament and, if not, say what the barriers to introducing that much overdue reform are? Will he also touch on recommendations 20 and 21 in the report, which refer to the need for a national review of maternity and paediatric services in areas that are remote, isolated and hard to recruit to? Indeed, the report goes further and says that the problem extends beyond those services. This is an issue we need to address to improve safety without deterring recruitment in these areas.

[Mr Hunt]

I am afraid I can only commit now to us introducing independent medical examiners as soon as possible. We are wholeheartedly committed to this. It is incredibly important for relatives, because where they have a concern about a death and possibly a mistake being made in someone’s care in their final hours, the availability of an independent examiner has been shown in the trials we have run to be very effective, so we are committed to doing that.

I should have answered the shadow Health Secretary on the point about a review of maternity services, because he raised it as well. NHS England is doing that review; we have already announced that to this House. Today it is publishing the terms of reference of that review. That is important, because there has been a big debate inside the health service—a debate with which many people will be familiar—about what the minimum appropriate size for maternity and birthing units is, and we need to get to the bottom of the latest international evidence.

Child and Adolescent Mental Health Services

Sarah Wollaston Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to open this debate on our report into child and adolescent mental health services. For the record, I am married to a full-time NHS adult forensic psychiatrist who is also the chair of the Westminster Parliamentary Liaison Committee for the Royal College of Psychiatrists. I thank the many organisations and individuals who have contributed to our report, my fellow Committee members and the Clerk of our Committee, David Lloyd for his exemplary leadership and work over the course this Parliament.

May I start by setting the scene? This report was launched in part because of the number of children and young people who were being admitted to hospitals many hundreds of miles from home when they were in mental health crisis and needing the highest level of support.

During the course of our inquiry, we identified serious and deeply ingrained problems with the commissioning and provision of child and adolescent mental health services, and we found that they ran throughout the whole system from prevention and early intervention services to in-patient services for the most vulnerable children and young people.

We welcomed the setting up by the Government of the Children and Young People’s Mental Health and Wellbeing Taskforce, and many of our recommendations were directed at that taskforce. I am sorry that it has not yet reported, but I understand that it is to report very shortly, and we look forward to seeing its recommendations. The taskforce knows that it is a matter not just of tweaking the CAMHS system but of fundamental change. I hope that it will clearly set out how that will be implemented. We have legislated for parity of esteem, we have written it into the NHS Mandate, but all that counts for nothing if it does not translate into better services for children and young people.

The key recommendation in our report is about the importance of prevention and early intervention. However, services cannot be planned without knowing the extent of the problem. It is a matter of great regret that the five-yearly prevalence survey was cancelled under the previous Government. That means that our data are 10 years out of date. I very much welcome the reinstatement of that survey. In his response, will the Minister give further details of the extent? I know that he has already announced that the funding has been identified, but many professionals are waiting to hear further detail about exactly what will be included. That would be very welcome.

While we wait for the prevalence data to appear—it would be nice to hear the expected time frame in which we will hear the results—we all acknowledge that there has been an alarming rise in the level of distress and need reported by all those who work in the field, including those in the voluntary sector, in teaching and in CAMHS. There are unprecedented levels of demand at a time when, unfortunately, 60% of local authorities that responded to a survey from YoungMinds report cuts or a freeze in their CAMHS budget. That is where the front line of prevention should be.

The compelling evidence that we heard throughout our report was that early intervention prevents children from presenting when they have become more unwell, so that is where we need to focus our resources. Clearly, the Government were right and everybody welcomes the investment in 50 extra beds in the areas of greatest need—some of which are in my area—but it costs around £25,000 a month for a child or young person to be treated in an in-patient setting. For every young person who is in one of those beds, we have to ask whether they would have needed to be admitted to hospital in the first place had those resources been properly directed to prevention services. We need double running. If we just keep investing in in-patient beds at the expense of prevention, we will fill those beds and there will be a demand for more.

I hope the Minister will recognise the need for double running so that we focus relentlessly on prevention and early intervention. As he will know, if we are looking at in-patients and admissions, the very last place that any young person should be at a time of mental health crisis is in a police cell. I pay tribute to all those who, over a number of years, have campaigned on that. The problem is not new. I am one of the few MPs—or perhaps not so few—who has been inside a police cell at night, because for many years I was a forensic medical examiner. It was always profoundly shocking to think that children as young as 12 or 13 across the west country were being taken into police cells under section 136 of the Mental Health Act 1983—an horrific experience.

It is sometimes an individual case that finally brings an unacceptable practice to an end. I pay tribute to Assistant Chief Constable Paul Netherton of Devon and Cornwall police for highlighting the awful case in Torbay of a child who was detained in a police cell, and I pay tribute to Chief Constable Shaun Sawyer because they have taken steps to bring the practice to an end. Although as a Committee we called for this to be a “never event” within the NHS, in effect the procedures that will be put in place will be equivalent. Finally, on this Government’s watch, we will see this unacceptable practice coming to an end. That is long overdue and very welcome.

In focusing on the need to keep that timely support for children and young people, I also hope that the taskforce will set out what can be done to address some of the perverse financial incentives in children and young people’s mental health services. For example, a child who is admitted to hospital no longer has to be funded by the clinical commissioning group—in other words, they are handed over to specialist commissioning— creating all sorts of inappropriate decision making in the system. It also means that children are more likely to be readmitted because there are no step-down services. Therefore, a focus on active intervention to try to prevent that admission and keep children at home is very important. I also look forward to hearing the taskforce’s recommendations on how that can be done consistently across the country, because another issue we raised was the extent of variation in practice.

I will now turn my attention to volunteers. If we are to retain a focus on the earliest intervention and prevention, we have to recognise the value of our volunteers. I would like to pay tribute to a number of volunteers in my constituency. I am a patron of Cool Recovery, a charity that provides mental health support to carers and those affected by mental health problems across south Devon. There are many such organisations working directly with young people. Representatives from Spiritulized, which supports young people in Kingsbridge, recently came to Parliament after being shortlisted for an award for the work it is doing in mental health first aid out in the community. In Brixham there is the Youth Genesis Trust and volunteers from The Edge. Work is also being done in schools. Representatives from South Devon college, which is based in my constituency, recently came to Parliament after it received an award for its work in student well-being and prevention of mental health problems.

Those organisations are reporting that both the demand for their services and the level of complexity have never been greater. Part of the reason for that, as the Minister will know, is the increasing waiting times for CAMHS. That means more young people are becoming much more unwell before being seen in the CAMHS setting. I hope that in his response he will be able to say exactly how we can balance that across the whole system. I very much welcome the investment in services for eating disorders and self-harm and early interventions in psychosis, and of course the Improving Access to Psychological Therapies programme. However, as he will know, fundamentally the issue comes down to funding. We will never achieve parity of esteem for mental health unless we address the funding inequality, with 6% of the mental health budget going to services for children and young people, and that budget itself is an inappropriately small slice of the overall funding pot for the NHS. How will we actually drive change in increasing funding?

[The Minister of State, Department of Health (Norman Lamb)]

I agree with everything my hon. Friend has said and very much welcome her Committee’s report. I agree on the need to address the funding issue. In particular, it is critical that we achieve what I call an equilibrium of rights to access between mental and physical health in order to address the awful problem on waiting times, and that must include children’s mental health services.

[Dr Wollaston]

I thank the Minister for that intervention. It is very welcome that we now have waiting time targets as a right for people with mental health problems, alongside those for people with physical health problems, but the challenge is not so much about the budget for children and young people’s mental health services, but what we take that from, because there are no areas of slack in the mental health budget, as he will know. I think that the mental health budget overall must achieve some parity. Again, if we look at prevention and the really small amounts of money, in relative terms, that are required to keep excellent voluntary services running in our communities, we see that it would be the greatest waste and tragedy to lose those vital services in our communities for the want of what are really quite small sums. When children, young people and voluntary services came to give evidence to our inquiry, we heard time and again that what they need is stable, long-term funding. They do not require a great deal of money, but they are currently limping from one short-term budget to another. Another issue raised was that if funding is available, it often gets directed to a new start-up project, not towards a project in the same community that may have proven value.

[Robert Flello (Stoke-on-Trent South) (Lab)]

The hon. Lady is no doubt aware that some of the small, really good charities will find that a bigger charity that is very good at filling in application forms will get the funding and then subcontract the work back to the small charity that was doing it before, having taken a cut of the funding as well.

[Dr Wollaston]

I absolutely agree. The other problem is that sometimes those larger national charities may have no local presence or understanding.

We need greater flexibility so that commissioners within health and local authorities are able to provide stable, long-term funding and to set the priorities for these new pots of money. It is always easy to announce new projects, but we must allow funding to be directed at existing services that have a fantastic proven track record. The value for money that we get from these services is extraordinary, as is the value that young people place on them. Young people have told me—this applies particularly to a rural constituency such as mine—that it is no good having a CAMHS service in a neighbouring town if they cannot get to it because there is no transport. That is why voluntary services are so particularly valued.

I was going to discuss our comments on schools, but my hon. Friend the Member for Brigg and Goole (Andrew Percy), as a former teacher, is far better placed to talk about that, so I will leave it to him to elaborate. I just want to touch on the new challenges that young people face with cyber-bullying, sexting, and image sharing. This is a 24-hour pressure; there is no safe haven for them in these circumstances. I welcome the fact that the taskforce will comment on not only the challenges but the opportunities that the internet may give us to assist young people.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

My hon. Friend is making some important remarks, as has her Committee. Somebody who suffers from a condition such as depression or anxiety, and has already been taught coping techniques, often finds it helpful to have a mentor. Perhaps apps, mobile phones or the like could reinforce those coping techniques at times when life seems difficult. That is an important part of the picture.

[Dr Wollaston]

I thank my hon. and learned Friend.

In using the internet, one of the challenges is how to know which of the sometimes thousands of resources that will pop up as a result of a search are valuable and to be trusted. It would be useful to have a mechanism for directing people to those that have the best evidence base behind them, and have been rated by young people as being the most helpful. While these kinds of resources may be welcomed by some people, they will not be the most appropriate for everybody. We need to have choice and a range of resources. That also applies to IAPT—improving access to psychological therapies. Cognitive behavioural therapy has an evidence base behind it, but it does not necessarily work for everybody. Those who do not find CBT helpful must have other avenues they can go down, including longer-term support where that is appropriate.

In closing, I draw the Minister’s attention to another area of early intervention—perhaps the earliest of all. Does he have any encouraging points to make on the provision of perinatal mental health services? I look forward to his response.

Jimmy Savile (NHS Investigations)

Sarah Wollaston Excerpts

Thursday 26th February 2015 Commons Chamber

[Mr Hunt]

Thank you, Mr Speaker. I did want to give a full response to the shadow Health Secretary, but I am happy to address any other concerns he has at a later stage.

[Dr Sarah Wollaston (Totnes) (Con)]

The Secretary of State has set out in the starkest terms the extent of the vile abuse perpetrated by Savile. It is also chilling to note in Kate Lampard’s excellent report that between 60% and 90% of child abuse is still going unreported. Those who perpetrate it are adept at adapting their mechanisms, and recommendation 9 in the report mentions the extent to which abusers use social media to abuse children on hospital sites. Can the Secretary of State tell the House whether he is going to implement recommendation 9, and if so, how that will happen?

[Mr Hunt]

Yes, we are; that is very important. We absolutely accept the principle that all hospitals must have explicit policies on the use of social media. We must do everything we can. It is difficult to stop people going on to Facebook, for example, but when it comes to internet access by children, there are things that we can do, and we will absolutely be implementing that recommendation.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

I do not disagree with it, but I will tell the hon. Lady why we are missing that one target. Incidentally, we are hitting the seven other targets. We are treating and diagnosing so many more people, with 560,000 more diagnoses every year. That means that in this Parliament we are treating 700,000 more people than were treated in Labour’s last Parliament, saving 1,000 more lives a month. If the hon. Lady looks at some of the other things that Cancer Research UK says, she will see that it welcomes that strongly.

[Dr Sarah Wollaston (Totnes) (Con)]

7. What assessment he has made of the implications for his policies of Her Majesty’s Treasury’s costing of free social care at the end of life.

[The Minister of State, Department of Health (Norman Lamb)]

HM Treasury’s costing demonstrates the limitations of data available nationally in estimating the potential costs of providing free personal care at the end of life. That is why the Department of Health is undertaking further work with stakeholders to develop an evidence base to inform the next spending review.

[Dr Wollaston]

I thank the Minister for that reply. He will know that most people want to be able to remain at home at the end of their lives, surrounded by the people they love, and I pay tribute to all the carers, volunteers and health professionals, including Rowcroft’s hospice at home, who help to make that possible. Sadly, he will also know that often the situation can break down because of the sheer exhaustion of caring for a loved one at the end of their life. Will he commit that the Government will consider the quality of care as well as the costs when considering introducing free end-of-life social care?

[Norman Lamb]

I thank my hon. Friend for that question and join her in paying tribute to the work of so many people: volunteers, loved ones and the professionals working in the community. The whole emphasis should be on ensuring that we respect people’s choice about where they want to be and that they get the best possible care. Later this week, the independent review of choice at the end of life will be published and I hope that it will inform discussions. I am completely with her in trying to ensure that we can achieve this.

Child and Adolescent Mental Health Services

Sarah Wollaston Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

First, let me caution against sanctimony. This is not a new issue: under the previous Labour Government, children did at times end up in adult wards. That is highly undesirable—everyone recognises that—and we must do everything we can to prevent it, but please do not try to claim that this is an entirely new problem. It is not. The Government have significantly increased the number of beds available, so significantly more are available now than there were in the last decade. The hon. Lady says that she sees increasing numbers of children held in police cells, but let us have some honesty and accuracy in this debate. The number of children who end up in police cells is falling, not increasing. The crisis care concordat, published last February, set a commitment to end the practice of children going into police cells. Indeed, we intend to legislate to ban it, but the numbers are lower than they were so she should not suggest that it is a growing problem—[Interruption.] She did suggest that.

The hon. Lady asked about my acting on the warning. That is exactly what we did. NHS England carried out a review of clinical judgment on the capacity required to meet children’s needs. As a result, there was a proposal for an increase of 50 beds nationally, focusing on the areas of the country where there was a significant problem, and the Government provided £7 million of additional funding to ensure that those beds were opened. Forty-six beds have opened. There is a temporary problem in Woking, where beds that were available are no longer accepting new admissions. That is a CQC issue. One thing that we have been absolutely steadfast on is that if standards are not being met, we should not continue to admit children to those wards.

The hon. Lady mentioned psychosis services, but this Government, for the first time ever, introduced a waiting time standard for early intervention in psychosis, which was widely welcomed by everyone in the mental health world. From this April, we start the process of introducing a standard. To start with, 50% of all youngsters who suffer a first episode of psychosis will be seen within two weeks and start their treatment within two weeks. That is an incredibly important advance.

The hon. Lady lectures the Government on mental health services, but perhaps she will consider why the Labour Government left out mental health when they introduced access and waiting time standards for all other health services. That dictates where the money goes and means that mental health loses out. This Government are correcting that mistake.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the extra beds committed to south Devon. The Minister will know that one of the most frequent points raised with the Health Committee in our recent CAMHS inquiry was the complete absence of accurate prevalence data on children and adolescents’ mental health needs and the services required to meet them. He will know that the prevalence data collection that used to happen every five years was cancelled in 2004. The Committee warmly welcomed the commitment to restart that survey. Will he update the House on exactly when that survey will start, whether the funds have been identified, and whether the scope of the prevalence data collection has been identified?

[Norman Lamb]

The hon. Lady is absolutely right. Unless we understand the prevalence of the problem, it is impossible to plan services effectively. I am delighted that we have secured the funding for an updated prevalence survey in 2015-16. It will be an expanded survey compared with the previous one. We want to cover as wide an age range as possible, to cover early years. That will give us the data, information and evidence we need, but I would then want us to do regular repeats to ensure that we maintain an understanding of prevalence.

NHS Major Incidents

Sarah Wollaston Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.

As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.

Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

[Dr Sarah Wollaston (Totnes) (Con)]

Our hard-working NHS staff and, more importantly, patients need to have absolute confidence that the Secretary of State will never lean on operational decision making in these circumstances and will always allow that decision making to take place at the appropriate local level, backed, if necessary, by national guidance.

[Mr Hunt]

My hon. Friend is absolutely right to say that. It is why many people in the NHS will be so astonished to hear the shadow Secretary of State, who presided over a culture where precisely that kind of leaning from on high happened, making it difficult for people to make those local operational decisions in the interests of patients, now trying to make a political point. This was a local decision and it was confirmed today that Ministers had no involvement in it, and Labour should stop trying to score political points.

NHS (Government Spending)

Sarah Wollaston Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

Labour Members are absolutely committed to saving the national health service from the fate that would befall it should the hon. Gentleman’s party have a further five years in office. We will absolutely not apologise for fighting tooth and nail to do what we can about, for instance, the staffing crisis that the NHS also faces.

[Dr Sarah Wollaston (Totnes) (Con)]

rose—

[Chris Leslie]

Before I give way to the hon. Lady, I shall tell her what is happening with staffing in the NHS. The NHS is now spending a further £500 million a year on agency nurses. Six thousand nurses who were trained in the UK have left the country and gone elsewhere, and 4,000 nurses are coming from overseas to try to back-fill some of those places. We are spending a fortune, day after day—far more than we ought to be—on these more expensive agency nursing staff. I know that as Chair of the Health Committee, the hon. Lady has a view on agency nursing within the NHS. Is she really content with the situation?

[Dr Wollaston]

I will write to the hon. Gentleman on that point, which is very important, but I wanted to respond to his question to my hon. Friend the Member for Dover (Charlie Elphicke) about why we dropped Labour’s policy of 48-hour access. I will tell him why, as a former GP who was there at the time: it was because patients could not get advance appointments. It caused enormous distortion of clinical priorities, and it was absolutely right that it was dropped, as called for by the profession. It was a ridiculous policy and it is absolutely right that it has been dropped.

[Chris Leslie]

The hon. Lady should know that there were provisions for advance appointments in the system that we had. Given that we have these pressures, with GPs being totally overstretched and having more and more people to deal with, and the shrinking number of GPs per head of population, she should not be surprised that we are in this situation. We have to do more to recruit and train more GPs. That is part of the way in which we would save the NHS from the situation that it is facing.

When all these different factors are combined with the high levels of winter flu and the growing population, we have an NHS in crisis—but there is an alternative. Yes, we have to repeal the competition-driven Tory changes, but we also have to deliver a sustained increase in resources and a fund designed urgently to alleviate the pressures. That is why, as shadow Chief Secretary, I want to take the time to talk about our £2.5 billion fund.

National Health Service

Sarah Wollaston Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I give way to the Chair of the Health Committee.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the right hon. Gentleman for giving way. I am concerned. Does he understand the difference between a pilot and an experiment? Does he not think it is right that the Secretary of State should listen to clinically led advice about how we might improve ambulance waiting times, rather than just roll out changes without a pilot, not an experiment?

[Andy Burnham]

I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do.

I need to hear today the Secretary of State’s plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.

[Dr Sarah Wollaston (Totnes) (Con)]

NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?

[Mr Hunt]

As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.

A and E (Major Incidents)

Sarah Wollaston Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.

In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday

“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”

to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.

The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:

“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.

What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?

The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.

[Dr Sarah Wollaston (Totnes) (Con)]

May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?

[Mr Hunt]

My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.