Five Year Forward View

Andy Burnham Excerpts

Thursday 23rd October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the “Five Year Forward View” for the national health service.

[The Secretary of State for Health (Mr Jeremy Hunt)]

NHS England, along with other NHS organisations, has today published its independent “Five Year Forward View”, which sets out its view of how the health service needs to change over the coming years. It is a report that recognises the real challenges facing the NHS, but it is essentially positive and optimistic. It says that continuing with a comprehensive tax-funded NHS is intrinsically do-able, and that there are

“viable options for sustaining and improving the NHS over the next five years.”

The report says that the challenges of an ageing population can be met by a combination of increased real-terms funding, efficiencies and changing the models of care delivered. It also says that

“decisions on these options will need to be taken in the context of how the UK economy overall is performing.”

In other words, a strong NHS needs a strong economy.

The report proposes detailed new models of care, putting out-of-hospital services front and centre of the solution, delivered through greater integration between primary, community and specialised tertiary sectors alongside national urgent and emergency networks. These can help to reduce demand significantly for hospital services and give older people in particular the personal care that we would all want for our own parents and grandparents.

The report talks about continued opportunities for efficiency savings driven by innovation and new technology, and suggests that they could be increased above the long-term run rate of efficiency savings in the NHS. It talks about reducing variation in the quality of care, in the wake of the tragedy in Mid Staffs, and about how the new Care Quality Commission inspection regime is designed to drive up standards across the system. It says that to do this we will need to move to much greater transparency in outcomes across the health and social care system. Finally, the report makes important points about better integrating the public health agenda into broader NHS activity, with a particular focus on continued reductions in smoking and obesity rates.

The Government warmly welcome the report as a blueprint for the direction of travel needed for the NHS. We will be responding to its contents in detail in due course, but we think it is an important contribution to the debate. We are proud of how the NHS has coped with the pressures of financial constraint and an ageing population in the last four years, but we also know that to sustain the levels of service that people want, the NHS needs to face up to change—not structural change, but a change in the culture of the way we care for people.

Given that the report has been welcomed on both sides of the House, I also hope that this can be the start of a more measured debate about the future of the NHS in which those from all parties in the House recognise our shared commitment to its future and focus on the best way to achieve the strong and successful NHS that the whole country desires.

[Andy Burnham]

A five-year forward view for the NHS, involving more than £550 billion of public spending, briefed to the media but not to Parliament—what clearer illustration could there be of the serious loss of public accountability arising from the Government’s reorganisation? The Secretary of State is in his place today only because he was dragged here by us. I do not know who runs the NHS these days, but I do know that it is certainly not him. We know why he wants to distance himself from this report: because it endorses key planks of Labour’s plan and leaves him with big questions to answer.

First, on GP services, does the Secretary of State agree with the report that primary care has been under-resourced and that people are struggling to get appointments? Will he accept its recommendation to stop his cuts to the GP budget, stabilise funding and match Labour’s plans to recruit 8,000 more GPs?

Secondly, on cancer, the report makes it clear that “faster diagnosis” is needed—we agree. So why did the Prime Minister yesterday dismiss Labour’s proposals for one-week cancer tests?

On integration, the report endorses Labour’s vision for new models of care, including hospitals evolving into integrated care organisations with more salaried GPs. Can the Secretary of State tell the House why he has spent the last few weeks attacking that plan, and is he now prepared to drop his opposition? On public health, is the report not right that the time has come for radical action on obesity, and will he now concede that his voluntary responsibility deal is simply not working?

It will not have escaped people’s notice that the report does not give one mention to competition—that is because it creates fragmentation, when the future demands integration. So will the Secretary of State commit to reviewing his competition rules and vote with Labour in four weeks’ time to repeal them?

Finally, on funding, the report could not be clearer: simply protecting the NHS budget in the next Parliament, as the Conservatives propose, will not prevent it from tipping into a full-blown crisis. As the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, has said, current Tory funding plans raise the spectre of rationing, longer waits and charges. Will he now drop them and match Labour’s plans for more money for the NHS? Labour has set out its plan, and today the NHS endorses that plan. The big question people are asking is: where on earth is his?

[Mr Hunt]

I talked about having a more measured debate, but I think I was speaking a trifle too soon, judging by what we have just heard. The right hon. Gentleman obviously was not listening to what I actually said, so let me just repeat to him that the Government warmly welcome this report. I talked about it as a “blueprint” for the future. He did not agree with setting up NHS England, and I do not think he agreed with the appointment of Simon Stevens as the chief executive, but we did that so that we would have a body that would think strategically about the long-term future of the NHS at arm’s length from the Government. That is what it has done, and the report is excellent.

The right hon. Gentleman and I have a sometimes slightly fractious relationship, but I would like to congratulate him this morning on his Houdini-like spin in the way he is approaching this report. He has been constantly telling this House that the NHS is on the point of collapse, but the chief executive of NHS England says that the NHS has been “remarkably successful” in weathering the pressures of recent years. The right hon. Gentleman has told this House constantly that the biggest threat to the NHS is privatisation and competition. This report, a five-year forward view, by bodies at arm’s length from the Government, contains not one mention of competition and privatisation as a threat, yet he says this report endorses Labour’s plans.

The right hon. Gentleman says, as has his leader, that the first thing he would do in government is repeal the Health and Social Care Act 2012 and strip clinical commissioning groups of their powers. He really should read the report carefully on that. He now says he welcomes the report, but it begs him not to carry out further big structural changes; it does not call for the repeal of the 2012 Act, and this is the report which he warmly welcomes today.

Then we need to consider money. The right hon. Gentleman told this House repeatedly that it was irresponsible to increase spending on the NHS, but now we have a report that says that the NHS needs real-terms increases, along the lines that this Government have been delivering in this Parliament. What does he say? He says, “It is great to have our plans endorsed by NHS England.” This report does not endorse Labour’s narrative; it exposes it for the shallow party politicking that we have had from him.

Let me say to the right hon. Gentleman that the really important message of this report is something we can agree on, and he should be talking about that. We both agree about the integration of health and social care, which is now happening. We both agree about improving investment in primary care. We both agree that we need more GPs. We both agree that we need more care closer to home. I think the public would say that we would have a more measured, intelligent and sensible debate—the kind of debate they want to hear—if we started talking about the things we agree on a bit more instead of constantly pretending there are vast disagreements.