Royal colleges, patient groups and other stakeholders have long warned the Government that the health and social care reforms brought about by the Health and Social Care Act 2012 would be distracting and cause chaos, and that such top-down reforms would stop the clinically driven reforms needed to help address the Crisis in A and E. That there is now a crisis engulfing accident and emergency services is beyond doubt.

Yet again we have no answers from the Prime Minister, who blames everyone but himself and denies that there is a Crisis in A and E. Let me give him one more chance to try to give an answer.

They have no answer and are not prepared to put anything on paper about how to get over this current Crisis in A and E. Does that not speak volumes?

It is time for Ministers to stop blaming others and to get a grip on the Crisis in A and E. Bluntly, what we are seeing today in A and E is the culmination of three full years of mismanagement of the NHS, with a needless top-down reorganisation and the waste of billions of pounds that could and should have been spent on front-line care.

Whatever the Minister claims, the reality is that the Secretary of State has lost grip of NHS finances just as he has lost grip of the Crisis in A and E. Earlier this month, we learned that half of all NHS hospital trusts are now predicting deficits - up from one in 12 last year.

That has all been handed back without giving staff a pay rise, even though there is a Crisis in A and E. We need more doctors, yet we know that for every 350 medical student places there are at least another 1,000 applicants who have met the criteria.