The Secretary of State has finally grasped that the A&E Crisis is a crisis of the whole system but NHS England persists in its foolish approach of blaming everyone but itself.

In addition to the Crisis in A&E, now acknowledged by the Secretary of State, we have hospitals full to bursting, the discharging of patients becoming ever more difficult, handovers to social care services slower and subject to more disputes and a social care sector struggling to fulfil the demands placed on it.

My Lords, the Crisis in A&E happened on this Government's watch as a result of the disastrous structural changes that they embarked on, the drastic cuts in social services and the disastrous launch of the 111 service.

Now, in mid October, many hospitals are facing an A&E Crisis.

My Lords, I congratulate my noble friend Lady McDonagh on having initiated a debate that enables us to draw attention to the serious Crisis in A&E, which is evidenced by people waiting long hours on trolleys or in ambulances, the consequence of social care cuts, the fact that walk-in centres are being reduced and that NHS Direct has been closed down, all of which aggravate the problem.

It is impossible in just three minutes to get across the scale of the problems and the anxiety and concern of local communities about the A&E Crisis that is unfolding before us as the winter sets in.

I beg to move, That this House is concerned about recent pressure in Accident and Emergency departments and the increase in the number of people attending hospital A&Es since 2009-10; notes a recent report by the Care Quality Commission which found that more than half a million people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in the last year; believes that better integration to improve care in the home or community can relieve pressure on A&E; notes comments made by the Chief Executive of NHS England in oral evidence to the Health Select Committee on5 November 2013, that the NHS is getting bogged down in a morass of competition law, that this is causing significant cost and that to make integration happen there may need to be legislative change; is further concerned that the competition aspects of the Health and Social Care Act 2012 are causing increased costs in the NHS at a time when there is a shortage of A&E doctors; and calls on the Government to reverse its changes to NHS competition policy that are holding back the integration needed to help solve the A&E Crisis and diverting resources which should be better spent on improving patient care.

Does he accept that, for all the actions that he has listed today, the fact is that too many vulnerable people are currently being exposed to too much risk in the NHS as a result of the Crisis in A&E?

As we have seen from recent coverage of the A&E Crisis, people feel that if they are asked to wait for hours, it is the end of the world.

Ultimately, resolving the current and on-going A&E Crisis involves a systematic change to the ways in which health and social care are organised.

We know now, as our population ages, how inadequate standards of accessibility - steep steps, narrow doorways, cramped bathrooms, having no downstairs loo, and so on - have helped to create an A&E Crisis.

Our A&E Crisis can recede because people can get home safely and it will be satisfactory when they get there.

People will not forget the time he accused hospitals of coasting when they were in the middle of an A&E Crisis, but even by his standards this was a staggering piece of spin.

Of course they are, but if we are going to cut district nurses every time there is a trust deficit like the one at Wythenshawe, we are not going to get through another winter without a much more Serious A&E Crisis.

The care cuts in the previous Parliament were the root cause of the A&E Crisis.

In my judgment, it is not just a question of the problems with care causing the Crisis in A&E; it is also the fact that many people cannot see their doctor when they want to.

There are many points that I could raise about York's NHS: the failing funding formula, which gives York £117 less per patient; the A&E Crisis, which is not unique to York; the crisis in the recruitment of staff, which is due to the pay freezes - 15% lost over the past five years - and the depleted public health services.