Today, I met up with Kate Scribbens (new Chief Executive of Healthwatch Surrey), and Matthew Parris (Evidence and Insights Manager). Healthwatch Surrey was set up to give patients a voice in local policy-making.

At our meeting, we discussed a recent Healthwatch Surrey survey on patients views around the sharing of records - and the balance of expectations between wanting efficient services, and concerns around safety and confidentiality.

We also discussed local GP practices, and the critical challenge of ensuring surgeries provide an effective appointment-making process whilst also conveying a reasonable sense of expectations to patients. Healthwatch Surrey will feed their findings in to the work Surrey County Council and the local Clinical Commissioning Groups are doing in both of these areas.

Today, I met up with Elizabeth Meatyard who set up Kingston Hospital Dining Companions. The initiative aims to provide patients at Kingston Hospital some companionship and help with eating at meal times.

There is a rota for volunteers, so the commitment is scaleable, and the program has increased from 30 to around 300 volunteers. It means imobile or elderly patients get some practical help with simple things (for example, removing wrappers around meals) as well as a some friendly company.

It's a great idea, and if you might be interested in getting involved with this or any of the other volunteering projects at Kingston hispital, please click here for further details.

Too many of the positive things going on in our community fail to get the attention they deserve. This morning, I returned to The Children's Trust, the amazing charity in Tadworth specialising in children's brain injuries. They do incredible work giving youngsters with the most heart-breaking of conditions hope of a better quality of life. It's one of those places that really moves you. I dropped in today to hear from the (relatively) new Chief Executive, Dalton Leong, on the Trust's plans for the future - both in developing the scope and remit of what they do in Tadworth, but also helping those youngsters with their ongoing rehabilitation once they return home.

Then, in the afternoon, I met up with Jonathan Quy. He is one of the Elmbridge community representatives elected to Kingston Hospital's Council of Governors. He's a local businessman with a young family, who was impressed with Kingston Hospital and wanted to put something back. So he stood for election, when Kingston Hospital achieved Foundation Status, and now he's our representative at the hospital. He will be joining me at some of my future local public meetings, so he can hear more from local residents and explain a bit about the direction of the hospital going forward.

I just discovered one of the most amazing places I have come across in Elmbridge - I am kicking myself it took so long! Green fingers, Paul Studholme, created the Medicine Garden out of the old overgrown kitchen garden at Cobham Park.

It is an incredible mix of things: a zen place to pause, forget about your cares or contemplate the meaning of life; an eco-site with a garden centre and beautiful surroundings, where local groups practise yoga, tai chi and circuit training; a business centre with an intriguing array of small businesses from curtain design to massage therapy; and a café brimming with atmosphere. Paul also set up a not-for-profit foundation to maintain the site as a community hub. You can find out more here.

On top of all that, with the drive of Bernadette Keane, the Medicine Garden is 'crowdfunding' to pay for a path linking the compass points that make up the design of the courtyard - with a tree symbolising a particular value at each point. Crowdfunding is an innovative way to raise money for good causes, setting a target to reach by a deadline, with each donor receiving a gift, and all donations returned if the target is not met. Sound interesting? Check out the website here, and support it if you feel able. Better still, visit the Medicine Garden and check out what's going on for yourselves. I guarantee you will love it.

Every now and then, as an MP, you come across a truly inspirational case. Today, I met with Darren Marcangelo (an Esher resident) whose daughter, Carina, is waiting for a heart transplant. She was born with cardiomyopathy, a disease of the heart muscles, and has been treated at Great Ormond Street and Royal Brompton hospitals.

Carina, who was 1 in February, is receiving excellent care and has been fitted with an internal cardiovercular defibrillator (like the one Fabrice Muamba has). But, she still urgently needs a heart transplant. I talked through the situation with Darren, and the family are hopeful that they will be allocated a donor soon.

As well as struggling with their own case, Darren and Mum Nicole have are championing awareness of the dire need for more young heart donors for those in desperate need of transplants. You can find out more from their website here. As a father of a 4-month old, I was struck by the bravery and courage of the whole family. I will join with the many others in hoping and praying that Carina gets the donor she needs soon.

Today, I wrote a piece for The Times, looking at the (limited) options the government has for managing the expected flow of migration from Romania and Bulgaria from the end of this year.

You can access the article here.

I joined Critical Care Parademedic, Mark, and Paramedic, Dina - as pictured below - part way through their 12 hour shift. We responded to a range of emergency calls, including heart failure and related accidents. From an MP's point of  view, it is important to see first-hand the challenges faced by those on the frontline, and talk through some of the issues. I was thoroughly impressed by the technical skill, calm professionalism and dedication Mark and Dina showed in what were quite daunting situations. They are a real credit to SECAMB, and a reminder to me of the invaluable service provided by our fabulous paramedics.

Yesterday, Erika and I went to a performance of the Three Musketeers at the Vera Fletcher Hall in Thames Ditton. Organised by Ruth Lyon and Karen Randolph, the dinner and panto raise money for new equipment at Thames Ditton community hospital.

It's always a great annual event. Erika and I went along - our first night out since the arrival of our new son, Peter - and it was a great evening with a rambunctious atmosphere! The Charles Court Opera came down from London to perform and they were absolutely superb, whilst Dairy Crest sponsored the event - all in aid of a great local cause. Congratulations to all those who put in the hard-work organising it, and we look forward to next year's event.

Today, I was given a tour of Walton Fire and Rescue Depot. Les Dodd and Paul Kenny explained how the station operates, including the mix of fire response and water-based incidents they have to deal with, coupled with the preventative side of their work in the community. I met with local officers (pictured below), and we discussed a range of matters - from the implications of the Surrey Fire and Rescue review, to the practical impact of health and safety regulation. I was thoroughly impressed with their dedication and professionalism, and very grateful for the tour and feedback.

On Friday, I met with Ken Brown (Chairman, League of Friends of Molesey Hospital) and Dr Steve Brant (local GP and pioneer of MEDICS Gateway) at the Glenlynn Practice in East Molesey (see photo below). In the context of the forthcoming abolition of Primary Care Trusts (PCT) and their replacement with local GP commissioning, I wanted to hear first hand about the prospects for Molesey hospital. I blogged on this issue in August last year, following a tour of the hospital.

The further feedback I received from Steve and Ken - not to mention other councillors - is that Molesey hospital is well placed to serve as a hub for the provision of local healthcare services, once we move to GP commissioning. There are potential advantages for GP consortia in having such a local hub, as well cost-efficiencies to be derived from delivering services closer to local people and reducing the rising number of visits and referrals to acute services at larger hospitals including Kingston (which are under increasing pressure).

However, the PCT has a large budget deficit due to past mismanagement. There are concerns that in order to balance its books, before GP commissioning arrives in 2012, the PCT may look to make short-sighted savings at the expense of Molesey and other community hospitals. I will be writing to the Chief Executive of the PCT to add my own concerns in this regard, seeking reassurances concerning plans for our community hospitals at Molesey and across Elmbridge, and asking what alternative cost-efficiency measures have been considered, including cutting administrative costs at the PCT itself.

Since August, I have been talking to local partners about the forthcoming NHS reforms. Over the last week I have had a series of useful meetings. First, I met with Surrey County Council to hear more about their plans to take on responsibility for 'public health' from the Primary Care Trust (PCT). This is a vital area of health policy, which involves disseminating information and promoting public awareness of important health issues - from leading healthier lifestyles, to preventing illness. In our consultations, I made it clear that this should not be a pretext for an extension of the 'nanny state'. Rather, policy will be subject to direct local democratic control, which means local health priorities set by those accountable to the community.

I have also been meeting with local GPs - from Molesey to Oxshott - to hear their views on 'GP commissioning', the plan to give consortia of local doctors the authority and responsibility to commission local health care priorities for their patients and local communities. Yesterday evening, I spoke to the Friends of Capelfield Surgery and listened to what local GPs and residents had to say.

The fundamental principle is that local GPs are better placed than the faceless and unaccountable bureaucracy of PCTs to set local health care priorities. There are a range of practical questions that the GPs have in relation to implementation - especially the responsibilities they will take on - but many were enthusiastic about the changes. The bottom line is that the PCT has been seriously mismanaged. But, not for lack of managers! In fact, there is far too much wasteful bureaucracy. In Surrey, the PCT has racked up an incredible £125million deficit.

Of course, the GPs may need bespoke support - from legal to business advice - but it ought to be more cost-effective for them to hire that in as they need it, rather than continuing with the current expensive and inefficient PCT structure. The new consortia won't be set up until April 2012. In the meantime, I look forward to continuing the dialogue with local doctors and residents, to help them facilitate the implementation of these plans.

As the forecasters duly proclaimed the end of the lingering summer weather, today saw downpours across Surrey. I was up before 6 a.m. to catch a ride with local paramedics (Aran Blunden and Katie Crabb, see below), and get a glimpse first-hand of the challenges they face on an ordinary shift. They responded to two people with respiratory problems and - no surprise - a traffic accident (thankfully not serious). This is, apparently, typical for the change in seasonal weather.

Paramedics, nurses and consultants all bemoan the distorting effect of paperwork and targets, and it is easy to see why. The form-filling is extraordinary. Much of it appears to be processed as a defence to litigation - the inevitable knock-on effect of the compensation culture. As a non-medic, one thing that interests me is the lack of discretion we give those on the frontline. If someone requests an ambulance to take them to hospital - no matter how trivial - standing orders are for paramedics to duly comply regardless of their judgement. In an increasingly consumeristic society - there are other words for it - this must absorb a significant amount of finite resources.

Aran and Katie demonstrated all the hallmarks of dedicated paramedics, with a true love of the job - come rain or shine - and an ardent commitment to helping those in need. They were far too professional to address the question of NHS reform or pay! But, it did get me thinking. According to Panorama, 6,500 NHS staff are paid more than the Prime Minister (i.e. above £142,500) and the highest paid NHS Chief Executive takes home almost double that, at £270,000 - but the highest paid paramedic earns just 10% of that amount. A recent report showed top NHS managers receiving a 7% pay rise in 2008/9, whilst nurses received a 3% uplift.

I have spent most of my career in public service. People drawn towards that kind of profession do it as a vocation. They know they will take a hit in salary compared to the private sector. I certainly did. It must rankle those on the frontline to see such discrepancies in pay compared to senior bureaucrats. The typcal rejoinder is that you need high salaries to compete for talent with the private sector. That is hard to stand up, when you actually look at the waste - and overall decline in productivity - in the NHS. Equally, the countervailing risk is that you undermine the ethos of public service and erode morale, when you penny-pinch the frontline to pay for a bloated and overpaid managerial class.