What steps he is taking to improve ambulance response times.

The Government have provided an extra £50 million of funding to ambulance services as part of our record package of support for the NHS this winter.

Notwithstanding what the Secretary of State has just said, the North East ambulance service has warned that it is under severe pressure caused by delayed ambulance turnaround times at hospitals such as Sunderland Royal. When Ministers embarked on their top-down reorganisation of the NHS, were they warned at any point that chaos would ensue in A and E departments?

The reforms the hon. Lady mentions mean that we have 9,000 more doctors, 3,000 more nurses and 2,000 more paramedics in the ambulance service. The point is that those reforms are putting money on to the front line, which means that the NHS is better equipped to deal with winter pressures than ever before.

In England around 75% of ambulances meet the target response time, as opposed to 60% in Wales. Will the Minister tell the House why ambulance response times are so much better in England than in the area of the United Kingdom run by the Labour party?

What is so disappointing about the health debate is that Labour Members tour TV studios trying to whip up a sense of crisis in the NHS in England, and then deny that things are even worse in Wales. Services are better in England because we have put more money on to the front line and less into management.

Prior to Christmas, a motorcyclist in my Constituency with serious leg injuries was left lying on the ground in the rain for an hour and 40 minutes waiting for an ambulance. Local people had to bring out blankets and hot water bottles to try to keep him warm, but because no ambulance arrived, the police had to commandeer a council minibus to take him to hospital. Is the Secretary of State ashamed to stand at the Dispatch Box and tell the House that the NHS is not in crisis, when that is what is happening on the ground?

Let me tell the hon. Lady what we are doing—[Interruption.] This is what I think is so shocking: Labour Members are not actually interested in what is happening to avoid precisely the kind of things that the hon. Lady mentioned. We are putting £4.6 million of extra support into the North West ambulance service this winter, and that money is being used to employ more paramedics, to train people so that they can see and treat patients on the spot, and to help more people on the phone so that they do not need an ambulance. The hon. Lady should perhaps have listened to the earlier question, because where Labour is running the ambulance services, results are even worse.

Does the Secretary of State agree that the rules for commissioning ambulance services need to be looked at again to ensure that ambulances serving rural areas such as South Lakeland which do not have an acute centre of their own and therefore export their ambulances further afield need to be compensated with additional ambulances to take account of the fact that so many of our vehicles are out of county most of the time?

My hon. Friend makes an important point about the way targets are set up. It is possible for ambulance services to hit their targets while not delivering a satisfactory service to the most rural areas, and we have discussed that issue a number of times. Because we are in the middle of a challenging winter, we do not think that now is the right time to review the issue, but he should rest assured that we are keeping it under review.

Although focus has been on A and E, it is becoming clear that the knock-on crisis in the ambulance service is more serious than people realise. Evidence is emerging of services unilaterally abandoning national standards and putting patients at risk. We know of one ambulance service that left patients at the door of A and E without handing them over to A and E staff, and last night East of England ambulance service was forced to release an internal report on the downgrading of thousands of 999 calls, including calls made by terminally ill patients. The report covered only a sample, but it showed that at least 57 of those patients died after a decision was taken not to send an ambulance. Withholding ambulances from terminally ill people is the most cruel form of rationing imaginable. Will the Secretary of State today order a full, independent investigation into how that happened, and into every death or adverse incident?

We investigate deaths and adverse incidents carefully, and the East of England ambulance service got £3.6 million of extra support to help it this winter. Let us look at what is happening in the ambulance service. Year on year, the number of the most serious category A calls—those that need to be answered within eight minutes—has increased by 26% over one year, and the number of ambulances dispatched within eight minutes has increased by 22%. That is 1,900 extra ambulance journeys arriving within eight minutes, which is a record of an ambulance service doing well under a lot of pressure. The right hon. Gentleman should be getting behind the paramedics and ambulance services, not trying to politicise the issue.

I raised a very serious issue, which came to light last night, regarding 57 terminally ill patients. As that was only a sample, it is not the whole story. I am surprised that the Secretary of State did not answer the very specific question about a serious failure in the East of England ambulance service. The truth is that this is not confined to the ambulance service in the east of England. Last year, we heard of a 77-year-old great-grandfather from Bolton who waited for more than four hours on a freezing pavement and a 92-year-old grandmother who tragically died after waiting for five hours in agony on the floor of her home in Muswell Hill.

Whatever the Secretary of State says, those are not isolated cases. New figures last week showed that in November a staggering 17,000 critically ill patients who were classified as needing an urgent category A 999 response waited longer than 19 minutes for an ambulance to arrive. Will the Secretary of State agree that this chaos is now putting lives at risk and cannot carry on? Will he tell the House what precise steps the Government are taking to bring responses to 999 calls back up to acceptable standards?

But we are taking measures. That is why we have 2,000 more doctors and 5,000 more nurses compared with a year ago. Frankly, the last thing those doctors and nurses on the front line want is scaremongering by the right hon. Gentleman—posters saying that the NHS might cease to exist under this Government; and leaflets like the one I have here from Lancaster saying that the local hospital might close. We are backing the NHS with more doctors, more nurses, more resources and a long-term plan. Will he now back the NHS by disowning this kind of scaremongering and stop trying to weaponise the NHS?