NHS (Five Year Forward View)

Jeremy Hunt Excerpts

Monday 1st December 2014 Commons Chamber

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

I wish today to make a statement on the future of our NHS, one that I hope everyone in this House will welcome. In October, NHS England and its partner organisations published an ambitious “Five Year Forward View” that was welcomed across the political divide. Today, I will announce how the Government plan to implement that vision.

Our response has four pillars. The first pillar is to ensure that we have an economy that can pay for the growing costs of our NHS and social care system: a strong NHS needs a strong economy. Some have suggested that the way to fund extra cost pressures is through new taxes, including on people’s homes. However, through prudent economic policies the Government can today announce additional NHS funding in the autumn statement without the need for a tax on homes. The funding includes £1.7 billion to support and modernise the delivery of front-line care, and £1 billion of funding over four years for investment in new primary care infrastructure. That is all possible because under this Government we have become the fastest growing economy in the G7.

The NHS itself can contribute to that strong economy in a number of ways. It is helping people with mental health conditions to get back to work by offering talking therapies to 100,000 more people every year than four years ago. The NHS can also attract jobs to the UK by playing a pivotal role in our life sciences industry. We have already attracted £3.5 billion of investment and 11,000 jobs in the past three years, as well as announcing plans to be the first country in the world to decode 100,000 research-ready whole genomes. Today, I want to go further by announcing that we are establishing the Genomics England clinical interpretation partnership to bring together external researchers with NHS clinical teams to interpret genomic information so that we go further and faster in developing diagnostics, treatments and therapies for rarer diseases and cancers. Too often, people with such diseases have suffered horribly because it is not economic to invest in finding treatments. We want the UK to lead the world in using genetic sequencing to unlock cures that have previously been beyond our reach.

The second pillar of our plan is to change the models of care to be more suited to an ageing population, where growing numbers of vulnerable older people need support to live better at home with long-term conditions such as dementia, diabetes and arthritis. To do that, we need to focus on prevention as much as cure, helping people to stay healthy without allowing illnesses to deteriorate to the point where they need expensive hospital treatment. Some have argued that to do that we need to make clinical commissioning groups part of local government and force GPs to work for hospital groups, but because that would amount to a top-down reorganisation we reject that approach. We have listened to people in the NHS who say that more than anything the NHS wants structural stability going forward, and, even if others do not, we will heed that message.

We have already made good progress in improving out-of-hospital care. This year, all those aged 75 and over have been given a named GP responsible for their care, something that was abolished by the previous Government. From next year, not just over-75s but everyone will have named GPs. Some 3.5 million people already benefit from our introduction of evening and weekend GP appointments, which will progressively become available to the whole population by 2020. The better care fund is merging the health and social care systems to provide joined-up care for our most vulnerable patients. Alongside that, the Government have legislated, for the first time ever, on parity of esteem between physical and mental health. To deliver world class community care, we need much better physical infrastructure. Today, I can announce a £1 billion investment fund for primary and community care facilities over the next four years. This will pay for new surgeries and community care facilities in the places where people most want them: near their own homes and families. These new primary care facilities will also be encouraged to join up closely with local job centres, social services and other community services.

Additionally, from the £1.7 billion revenue funding we are also announcing, we will make £200 million available to pilot the new models of care set out in the “Forward View”. To deliver these new models, we will need to support the new clinical commissioning groups in taking responsibility, with partners, for the entire health and care needs of their local populations. So as well as commissioning secondary care, from next year they will be given the opportunity to co-commission primary care, specialist care, social care, through the better care fund, and for the first time, if local areas want to do it, public health. The NHS will therefore take the first steps towards true population health commissioning, with care provided by accountable care organisations.

A strong economy and a focus on prevention are the first two pillars of our plan. The third pillar is to be much better at embracing innovation and eliminating waste. We are making good progress in our ambition for the NHS to be paperless by 2018, and last month the number of A and E departments and ambulance services able to access summary GP records exceeded a third for the first time, while from next spring, everyone will be able to access their own GP record online. However, today, I want to go further: £1.5 billion of the extra £1.7 billion revenue funding will go on additional front-line activity. To access this funding, we will ask hospitals to provide assured plans showing how they will be more efficient and sustainable in the year ahead and deliver their commitment to a paperless NHS by 2018.

We also have to face the reality that the NHS has often been too slow to adopt and spread innovation. Sometimes this is because the people buying health care have not had the information to see how much smart purchasing can contain costs, so from next year CCGs will be asked to collect improved financial information, including per-patient costings.

The best way to encourage investment in innovation is a stable financial environment, so I can today announce that the Government, in collaboration with NHS England, will give local authorities and CCGs indicative, multi-year budgets as soon as possible after the next spending review. We expect NHS England and Monitor to follow this by modernising the tariff to set multi-year prices and make the development of year-of-care funding packages easier.

The NHS also needs to be better at controlling costs in areas such as procurement, agency staff, the collection of fees from international visitors and reducing litigation and other costs associated with poor care. I have announced plans in all these areas, and we will agree the precise level of savings to be achieved through consultation with NHS partner organisations over the next six months. This will lead to a compact signed up to by the Department, its arm’s length bodies and local NHS organisations, with agreed plans to eliminate waste and allow more resources to be directed to patient care.

The final pillar of our plan is the most important and difficult of all. We can find the money; we can support new models of care; we can embrace innovation, but if we get the culture wrong, if we fail to nurture dignity, respect and compassionate care for every single NHS patient, we are betraying the values that underpin the work done every day by doctors and nurses throughout the NHS. We have made good progress since the Francis report: a new Care Quality Commission regime, six hospitals turned around after being put into special measures, 5,000 more nurses on our wards, the My NHS website, and 4.2 million NHS patients asked for the first time if they would recommend to others the care they received.

In the next few months, however, we will go further, announcing new measures to improve training and safety for new doctors and nurses, launching a national campaign to reduce sepsis and responding to recommendations made in the follow-up Francis report, tackling issues of whistleblowing and the ability to speak out easily about poor care.

Under this Government, the NHS has, according to the independent Commonwealth Fund, become the top-ranked health care system in the world. In 2010, we were seventh for patient-centred care, and we have now moved to the top. Under this Government, we have also become the safest health care system in the world. But with an ageing population, we face huge challenges.

How we prepare the NHS and social care system to meet those challenges will be the litmus test of this Government’s ambition to make Britain the best country in the world in which to grow old. We are determined to pass that test, and today’s four-pillar plan will help us to do just that. Our plan will need proper funding, backed by a strong economy, so I welcome yesterday’s comment by Simon Stevens that when it comes to money, the Government have played their part.

However, we also need ambitious reforms of the way we deliver care, focusing on prevention, innovation and a patient-centred culture that treats every single person with dignity and respect—proper reforms not as a substitute for proper funding, but as a condition of it. A long-term plan for the economy; a long-term plan for the NHS—I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

This weekend a 16-year-old girl in need of a hospital bed was held for two days in a police cell because there was not a single bed available for her anywhere in the country. As we have warned before, this is by no means an isolated example: the BBC reported on Friday that seven other people had died recently waiting for mental health beds. But it is not just mental health: last week I told the House of a stroke patient ferried to hospital by police on a makeshift stretcher made from blinds in his house. That patient later died. This is one of a number of alarming reports of people waiting hours in pain and distress for ambulances to arrive.

Listening to the Secretary of State for over 10 minutes today, one would have no idea that any of that was happening in the NHS right now—and that is the problem: nothing he has said today will address those pressures ahead of this winter. On mental health, does he not accept that there is an undeniable need to open more beds urgently —right now, this week—to stop appalling cases like the one we heard about at the weekend? What assessment has he made of the ability of the ambulance service to cope this winter? Is there a case for emergency support, on top of what has already been announced?

This statement offers no help now to an NHS on the brink of its worst winter in years, but there is another major problem with it. The weekend headlines promised £2 billion extra for the NHS, but the small print revealed that it is nothing of the sort. I note that the Secretary of State did not use the figure of £2 billion once in his statement, but that is what the NHS was led to believe it was getting. False promises and cheques that bounce one day after they are written are of no use to doctors and nurses struggling to keep services going. We all remember the omnishambles Budget unravelling the day after it was given, but an autumn statement unravelling three days before it has been delivered is a first even for this Government.

Will the Secretary of State confirm that £700 million of the £1.7 billion he talked about is not new money, but already in his departmental budget? A few weeks ago his Department told the Public Accounts Committee that it expects to overspend this year by half a billion pounds. His Department is in deficit right now. If that is the case, would he care to tell us where this £700 million is coming from and what services he will be cutting to pay for it? He mentioned research. At the weekend we exposed NHS England’s plans to cut the funding for clinical trials, which would have affected thousands of very poorly patients. Was that one of his planned central cuts to pay for this funding? Will he now guarantee that funding for research and clinical trials will not be cut?

But it gets worse. Not only is £700 million recycled; we gather that the other £1 billion will be funded by cuts to other Departments. The Institute for Fiscal Studies has warned of “staggeringly big cuts” to local government in the next Parliament. The NHS Confederation has said:

“If additional NHS funding comes at the expense of tough cuts to local government budgets, this will be a false economy as costs in the NHS will rise.”

Have the Government not learnt the lessons of this Parliament: that the NHS cannot be seen in isolation from other services, particularly local government, and that cutting social care only leads to extra costs for the NHS? Figures released on Friday revealed record numbers of older people trapped in hospital because the care was not there for them at home. That is happening on the Secretary of State’s watch.

This is the human consequence of the severe cuts to social care in this Parliament, and it is clear that this Government are preparing to do the same again in the next Parliament if they are re-elected. This is why hospital A and Es have missed the right hon. Gentleman’s own target for 71 weeks running. We also have cancer patients waiting longer for treatment to start, and everyone is finding it harder and harder to see a GP.

Is it not the case that most of what the Secretary of State has announced will go to patching up the problems he has created, leaving less than a quarter for the new models of care outlined in the “Forward View”? Let me remind him that policies such as a year of care for vulnerable patients and having accountable care organisations were developed by the Opposition, and for him to stand there today and lecture us about reorganisations of the NHS—well, I did not think that even he would have the nerve to do that.

The truth is that what the Secretary of State has announced provides nothing for the NHS now and is not what it seems, and because of that it will not be enough to prevent the NHS from tipping into full-blown crisis if the Tories are re-elected next year. They will not be able to find any more money for the NHS than this, because they have prioritised tax cuts for higher earners and have not yet found the money to pay for them. That explains their desperate attempts to inflate these figures and make them sound more than they are. Is it not the case that to deliver the “Five Year Forward View”, the NHS needs truly additional money on the scale proposed by Labour—an extra £2.5 billion over and above everything the Secretary of State has promised today, and an ambitious plan for the full integration of health and social care.

They said they would be the Government who cut the deficit, not the NHS, but it is the Health Secretary who has created a deficit in the NHS. It is because of that deficit that cancer patients are waiting longer, A and E is in crisis and children are being held in police cells, not hospital beds. He had nothing to say to those people today. They deserve better than a Chancellor fiddling the figures and a Health Secretary spinning the facts.

[Mr Hunt]

This is the day on which Labour’s attacks on the NHS have been shown up for what they are—every bit as shallow as their attacks on the economy. The country knows that we are addressing the squeeze on NHS funding caused by Labour’s wrecking of the British economy.

The right hon. Gentleman called today’s announcement “patching up the problems”. If growing the economy so that we can put more money into the NHS is patching up problems, how would he describe shrinking the economy and then cutting the NHS budget, as he wanted to do? He said that £2 billion of new money was a false promise. It was not a false promise: it was the truth—£1 billion of additional funding from the Treasury and £1 billion from the forex fines. That is £2 billion of new money, which has been welcomed by the King’s Fund today as a big step forward, and by the NHS Confederation, the Foundation Trust Network and Simon Stevens, the head of NHS England and former Labour No. 10 health adviser. This is a very significant moment when, after years of taking painful decisions to get the economy back on track, we can at last put more money into the NHS. The right hon. Gentleman should welcome it, not scorn it.

The right hon. Gentleman talked about deficits in the NHS. We will take no lessons on deficits from the Labour party—the party that left the country its biggest level of unfunded spending commitments in peacetime history. The truth is that now, with a strong economy that Labour could never deliver, we are putting things right.

The right hon. Gentleman talked about problems with care in the NHS, and the one thing that no one ever says about me is that I am a Health Secretary who shies away from those problems. The trouble is that every time I talk about problems with care in the NHS, he says it is running down the NHS. It is not running down the NHS to confront the problems of poor care. He also talked about the issue of police cells, but we are on track to reduce the number of mental health patients using them by 50% over the next few months.

As for pressures on the NHS front line, it is not that all Health Secretaries do not have to confront them; it is whether or not we sort them out. When it comes to poor care in hospitals such as the Medway and hospitals in Colchester, Basildon and Burton, this Government are sorting out those problems, while the previous Government swept them under the carpet. The right hon. Gentleman used the word “spin”, but he might like to reflect on the massive harm done to patients when under a Labour Government poor care was covered up by Labour spin—surely it was Labour’s darkest period ever when it came to running the NHS.

Government Members have a long-term plan for the economy, and a long-term plan for the NHS. By contrast—[Interruption.] Opposition Members might listen to the truth about the NHS. By contrast, the Labour leader said recently that he wanted to “weaponise” the NHS. He wanted to turn the NHS into a weapon—a weapon to get Labour votes. No, Mr Speaker, the NHS is not a weapon for political parties. It is there to help patients and to save lives, not to save political spins. Under this Government, it will always be there for patients: that is what this Government will deliver.

[Several hon. Members]

rose—

[Mr Speaker]

Order. For the avoidance of doubt—because there was some consternation about this matter—let me say that I am sure the Secretary of State is not making an allegation of any personal dishonesty on the part of any Member. It would simply not be legitimate to do so.

[Mr Hunt]

indicated assent.

[Mr Speaker]

The Secretary of State confirms that he is not making any allegation of personal dishonesty against any individual. Enough: we are grateful. We will leave it there for now.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the statement. The extra funds for the NHS constitute a clear endorsement of Simon Stevens’s excellent “Five Year Forward View”. I particularly welcome the announcement of multi-year budgets and investment in patients’ ability to control their own records. Will the Secretary of State confirm that the process of creating paperless NHS hospitals will move seamlessly from primary to secondary care, and will be controlled by patients themselves?

[Mr Hunt]

The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients’ consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will the Secretary of State tell the House how much money is now being diverted from patient care to the negotiation of legally binding contracts between commissioners and suppliers of services, or will he confirm that he cannot do so because he does not bother to collect the information?

[Mr Hunt]

What I will confirm to the right hon. Gentleman is that the rules on the contracting out of services are the rules that we inherited from the Labour Government, although he personally might not have introduced them had he remained Health Secretary throughout those 13 years.

[Mr Adrian Sanders (Torbay) (LD)]

May I focus for a moment on a constituency case? Last Thursday, a 16-year-old was placed in the custody centre at Torquay police station. What is of concern is that there is nothing new about that. In Devon and Cornwall alone, there have been 700 cases of people with mental health problems being placed in police cells. The problem for this young woman was that, at that point, not a single facility could be found anywhere in England to meet her needs. It really is outrageous that that could happen to a 16-year-old girl in this day and age. Where does the statement mention the fourth-tier funding to provide facilities that are clearly needed, and have been needed for years?

[Mr Hunt]

The hon. Gentleman is absolutely right. It is totally unacceptable for someone with severe mental health problems to be placed in a police cell. We are making very good progress in reducing the use of police cells for that purpose, with the active support of the care services Minister, my right hon. Friend the Member for North Norfolk (Norman Lamb). In the specific case to which the hon. Gentleman has referred, a bed was available but there was poor communication on the ground, which is why we were not able to solve the problem as quickly as we would have liked. As soon as NHS England was informed of the problem, it was able to find a bed within, I think, about three hours. However, as he says, this is a problem that we must eliminate.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

If that amount of new money is indeed going into the NHS, will the Secretary of State tell us how much of it will be dedicated to—perhaps even exclusively used for—better delivery of mental health services, not least services for child and adolescent mental health patients?

Let me point out to the Secretary of State that this is not the first occasion on which the House has raised with the Government the total failure to provide adequate services for people with mental health issues. The matter was most recently highlighted at the weekend, but it has been highlighted in the Chamber more than once in the recent past. What the Secretary of State has said today certainly does not calm my fear that if my constituents need a mental health bed, they will not find one in London, and heaven only knows how many hundreds of miles they may have to travel before they do find that security.

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[Mr Hunt]

I hope I can reassure the hon. Lady, because today’s announcement includes £1.5 billion extra for the NHS front line next year. That will include mental health services, and we would expect commissioners to observe parity of esteem as they decide how to allocate those additional resources. It also includes £1 billion to improve primary care facilities, which will be used by many mental health patients. There is a lot in today’s announcement that I hope will relieve pressure. She is right to say that we need to do better on child and adolescent mental health services. This has been a long-standing problem, but we have been taking forward some important work to make a reality of our commitment to parity of esteem, which is something we are very proud to have legislated for.

[Sir Nicholas Soames (Mid Sussex) (Con)]

May I report to my right hon. Friend that, despite the dismal rant he heard from the shadow Secretary of State, the Princess Royal hospital in Haywards Heath and the Royal Sussex county hospital in Brighton, and their doctors and nurses, are doing a magnificent job in treating local people? Will he also accept that the problem with mental health services in this country goes back a long way? It will not be fixed overnight. I have had the same problem in my constituency of someone being put in a police cell. The problem fell entirely on the staff of the local trust, who simply did not deal with the matter properly. This is going to take a long time to fix, and I greatly welcome my right hon. Friend’s statement.

[Mr Hunt]

I thank my right hon. Friend for his comment, because the use of police cells is not an issue with which we should be playing party political games. As it happens, their use was much higher under the last Labour Government. We are starting to address that issue, and he is right: even one person spending a night inappropriately in a police cell is one person too many. That is why we are making good progress, but in the end it will require people who purchase health care in local areas to look at people with mental health needs in a holistic way—not just trying to solve issues problem by problem, but looking at and addressing the whole problem and making sure they get the treatment they need.

[Mr Ben Bradshaw (Exeter) (Lab)]

The Secretary of State should not be at all surprised by this terrible case of the young girl kept in a police cell in Devon over the weekend, because I and other Members have been raising this personally with him for at least the last three years. What has he been doing over that period to address the scandal of young people’s mental health services in Devon and nationally?

[Mr Hunt]

I will tell the right hon. Gentleman what I have been doing: I have been putting in place a strategy that will see over the next few months a reduction of 51% in the number of mental health patients who use police cells. That is progress. It still means that there are too many people in police cells, but I would just gently urge him not to try to make party political capital out of this, because a higher number of them were used under the last Labour Government. We are addressing a long-standing problem in a responsible way, and are determined to go further.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I welcome every word of my right hon. Friend’s statement, not least because his fourth pillar on culture change echoes the work done by the Public Administration Committee on complaints handling and the need for openness. His statement addresses all the needs and challenges we face in north-east Essex: the problems of openness and transparency in the local hospital and the need to transfer more of what the hospital does back to the community providers—to the multidisciplinary providers that need to be in the community. I welcome the £1 billion fund for developing community facilities, but how is he going to persuade the CCGs to transfer some of their commissioning power to these units? A hospital in Harwich, which was built under the last Labour Government, has two operating theatres that have never been used because the CCG, and its predecessor the primary care trust, would not commission services through those facilities.

[Mr Hunt]

I thank my hon. Friend for his long-standing support for the importance of transparency in driving up standards in health care. He has championed that for his own hospital, which has had particular issues on that front, but also through his role in this House, and he is absolutely right to do so. On his substantive point, we will get CCGs to do what he suggests through the reforms that I have announced, which will encourage them to take a holistic view of the health care received by the patients for whom they are responsible. In particular, we have got to move away from commissioning care piecemeal—commissioning a certain number of hips or a certain number of mental health consultations—and start looking at patients and all their needs in the round. If we commission in that way, we can avoid a number of the human tragedies that have come to light.

[Lady Hermon (North Down) (Ind)]

Will the Secretary of State kindly confirm that the Chancellor will include in his autumn statement on Wednesday an obligation on the Northern Ireland Executive to ensure that if, as we expect, further funding for health is devolved to Northern Ireland, it is ring-fenced so that it is spent exclusively on health? In that way, GP beds in community hospitals such as mine in Bangor—in North Down, not north Wales—can be reopened. Those beds were closed today, 1 December, causing enormous trauma and distress to the patients and staff there.

[Mr Hunt]

The system involves Barnett consequentials. As a result of today’s announcement, extra money will go to the devolved Administrations and we hope that they will use it for health purposes, but they do have a choice. The hon. Lady has just made the case extremely elegantly for that money to be put into health. She mentioned north Wales, and I know that Members on this side of the House will be hoping that the Welsh Government will also use the extra money for the NHS, given the profound problems in the Welsh NHS.

[Richard Fuller (Bedford) (Con)]

Dementia care for our parents, grandparents and loved ones is a growing issue for my constituents, and I congratulate my right hon. Friend on putting dementia care at the centre of what he is trying to do. I also congratulate the Bedfordshire clinical commissioning group on its recent review. Will he tell us what today’s announcement will do to help to support those parts of the country that are trying to make progress on dementia care?

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[Mr Hunt]

I am happy to do so. We have made good progress during this Parliament, increasing by 10% the proportion of people with dementia who receive a diagnosis. This is not just about getting a diagnosis, however; it is the care and support that people get when the diagnosis is made that really matter. That is the reason for giving the diagnosis. Let me characterise the change that we want to see for people with dementia over the next few years. When someone gets a diagnosis, we want to wrap around them all the care and support that they and their family need to help them to live healthily and happily at home for as long as possible, so that they do not get admitted to hospital in an emergency or need to go into residential care until the very last moment. Of course that will cost the NHS less, but it is also far better for the individual concerned.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State talks about party politics, but he cannot get away from the fact that the number of mental health beds in this country has dropped by 1,500 on his watch. We have heard about the scandal in Devon last week, and my hon. Friend the Member for Hampstead and Kilburn (Glenda Jackson) has told the House how some patients have to travel up to 200 miles to access an emergency bed. What is the Secretary of State going to do to deliver those beds where the mental health patients who are in crisis actually need them, which is close to their homes?

[Mr Hunt]

I agree with the hon. Gentleman that we need to address the issue of availability of mental health beds for crisis care, but we also need to recognise that the model of care for people with mental health needs is changing. We think that it is much better to avoid long-term institutionalisation if we possibly can, and that is why there has been a process of reduction in the number of beds. That happened under the Labour Government as well. If he wants to know what I am doing, I will tell him. I am part of the Government who are delivering a strong economy, which means we can put more money into the NHS.

[Mr Mark Hoban (Fareham) (Con)]

I commend my right hon. Friend for securing £1 billion from the Chancellor to modernise primary care services. I know that the GPs in my constituency will welcome that, because they often cannot provide additional services owing to capacity constraints. May I urge him to ensure that, when money is spent from the fund, it is linked to delivery in relation to the proposals set out by Simon Stevens for improving primary care, for better provision locally and for closer integration with hospitals?

[Mr Hunt]

My hon. Friend is absolutely right. This will help to improve primary care premises and facilities. I know that there is an urgent need to upgrade a number of GP surgeries and primary care facilities, but this is not essentially about buildings. It is about new models of care. The single big change that we need to see over the next five years is in the role of GPs, so that they have the capacity and the desire to take proactive responsibility, particularly for the most vulnerable people on their lists, including people with long-term conditions such as dementia, diabetes and asthma. To do that, they will need better facilities—bigger facilities—and the ability to carry out more diagnostic tests in their surgeries, and I think that this funding will make a big difference.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Will the Secretary of State confirm a report in The Guardian today that he shelved the downgrading of the majority of accident and emergency departments in England under the Keogh review because that is “political suicide” and because of criticisms from the College of Emergency Medicine, the Care Quality Commission and chief executives of trusts? Will this mean that he can now suspend Shaping a Healthier Future and remove the threat to the Charing Cross and Ealing A and Es?

[Mr Hunt]

I am always happy to confirm that a Guardian story is wrong. Let me tell the hon. Gentleman that there was no plan to downgrade the majority of A and Es. The plan is to invest in A and Es—to continue with broadly the same number of A and Es as we currently have but to recognise that some of them will need to specialise in different things. We will stick to that plan—it is a good one.

[Paul Burstow (Sutton and Cheam) (LD)]

I very much welcome the statement and, in particular, the Secretary of State’s ambition that Britain should become the best place in the world to grow old in. Given that home care is an essential part of maintaining frail older people and enabling them to remain in their own homes, and given that well-paid, well-trained and well-motivated home care staff enable people to stay in their own homes and families to juggle work with caring responsibilities, will he direct some of the extra £2 billion to the better care fund, so that it goes directly into social care so that these services can actually be provided?

[Mr Hunt]

First, I agree with the point that my right hon. Friend is making: home care is going to become an increasingly important part of what the NHS and social care systems deliver. I want them to deliver it in an integrated, joined-up way, and £200 million of the £1.7 billion going to the NHS front line is to help develop new models of care. I think that improved home care could be a very real way we do that.

[Keith Vaz (Leicester East) (Lab)]

The “Five Year Forward View” recommended a five-year programme to prevent type 2 diabetes that is evidence-based. How much of the money that the Secretary of State has announced today will be specifically about preventing diabetes, so that in the long run we will save even more money? At the moment, health and wellbeing boards are under no obligation to spend any part of their budget in a specific way on diabetes.

[Mr Hunt]

First, I congratulate the right hon. Gentleman on his campaigning on diabetes. I have looked at this carefully as Health Secretary and I looked at the possibility of ring-fencing certain sums in the budget for conditions such as diabetes, but the advice I received was that the broader change we need to make is in the whole mentality across the NHS for dealing with all long-term conditions, not only diabetes, but arthritis, dementia and chronic obstructive pulmonary disease. That is because within a couple of years we will have 3 million people who have three or more long-term conditions, one of which is often diabetes. Will a real focus of the change we want to see in the NHS be on people with long-term conditions? Yes, I would say that that is the biggest focus of all in the change we want to see over the next five years.

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[Sarah Newton (Truro and Falmouth) (Con)]

I welcome today’s announcement of the national sepsis prevention campaign, which will make a such a difference to people in Cornwall and all around the UK. Will my right hon. Friend continue to work with the all-party group and the UK Sepsis Trust to implement the sepsis six, which it is estimated will save 12,500 lives and £2 billion for the NHS every year?

[Mr Hunt]

Yes, I will. I have to say to the House that the importance of being better at tackling sepsis was brought home to me personally by two moving meetings with Scott Morrish, the father of Sam Morrish, who was from the west country—perhaps near my hon. Friend’s constituency. His son’s tragic death from sepsis was avoidable, so this is an absolute priority for me in the next couple of months.

[Clive Efford (Eltham) (Lab)]

Two weeks ago, the Secretary of State could not muster enough Conservative MPs in this House to defend the Health and Social Care Act 2012, particularly those elements of it that have allowed competition regulators into the NHS to second-guess decisions of local commissioners. If he wants to save money in the NHS, he can do away with that element of the 2012 Act and stop money being diverted from patients to pay for lawyers and accountants to oversee a tendering process that is wasting money.

[Mr Hunt]

If we stopped the NHS using the private sector, which seems to be Labour’s direction of travel, 330,000 people every year would have to wait longer to have their hips or knees replaced. We will make decisions on the basis of what is right for patients, and not of ideology.

[Richard Drax (South Dorset) (Con)]

I congratulate my right hon. Friend on his remarks and thank him for the extra £1 billion for primary care. In South Dorset, I hear many complaints about the agency fees for recruiting staff, which is one reason why trusts tend to recruit nurses from abroad—from places such as Spain. Will he look at that and see if there is some way we can save a bit of money and act a little more efficiently?

[Mr Hunt]

We are spending too much on agency staff. It is fair to acknowledge that one reason why NHS trusts are doing that is in reaction to the Francis report. They want to ensure that they have proper staffing on their wards and proper staffing quickly. We have introduced transparency to encourage them to do that. As things settle down, they need to transfer more of those staff on to proper permanent contracts, because it costs the NHS too much to pay those exorbitant agency fees.

[Ann Coffey (Stockport) (Lab)]

I welcome any extra funding for the NHS, but will the Secretary of State ensure that it is fairly distributed, as on the current funding formula, Stockport is 4.9% from target, and that is affecting the ability of the clinical commissioning team to develop health services in the community as an alternative to emergency admissions to Stepping Hill hospital?

[Mr Hunt]

I recognise the hon. Lady’s concern about the way funding is allocated, and it is a concern that is shared in all parts of the House. It has been very difficult to get that right in a period when NHS funding has not been going up by large amounts, but that matter is now decided at arm’s length from Ministers by NHS England. It will make its decisions at a board meeting on 17 December, and I will make sure that I relay to it her concerns.

[Margot James (Stourbridge) (Con)]

Does my right hon. Friend agree that all patients, especially older and vulnerable patients, deserve the security of an NHS funded out of general taxation rather than part-funded by an unpredictable and opportunistic tax on people’s homes as proposed by the Labour party?

[Mr Hunt]

The trouble with a mansion tax is that, in the end, it will apply not to mansions but to homes, flats and people on low incomes. That is why it is the wrong way to put more funding into the NHS. The right way to do it is to have a strong economy, and only this Government can deliver that.

[Karl Turner (Kingston upon Hull East) (Lab)]

Up until her retirement, my mother was a very proud and committed nurse in the NHS. The Secretary of State wears a lapel badge pretending his love for the NHS. Today, my mother asked why, if the Secretary of State had £700 million in his Department, could he not have afforded the measly 1% pay rise for our committed nurses in the NHS, which would have cost £200 million.

[Mr Hunt]

It really demeans debate in this House to go on about some phoney argument that one side of the House cares about the NHS while the other does not. We have shown our commitment to the NHS by announcing today £2 billion of additional funding. That is a big deal and it shows our commitment. We have also given all nurses a 1% pay rise.

[Andrew George (St Ives) (LD)]

I welcome the additional money. My right hon. Friend is right that health providers need a stable financial environment, but many of them have been left with a debilitating legacy of debt. The Royal Cornwall Hospitals Trust in my own area has a legacy of debt, which is just a fraction of the amount by which the Government have admitted that they have underfunded the local health economy over many years. Rather than having distorting activity going on in that trust, would it not be better for it to start with a clean sheet of paper and to build for the future rather than constantly having to work from a position of debt?

[Mr Hunt]

I sympathise, because the previous Labour Government left hospitals with more than £70 billion of PFI debts. Those debts must be paid off and that money cannot be spent on front-line patient care. We have done what we can on a case-by-case basis to help trusts deal with those debts. It is extremely difficult when resources are tight and of course I will consider the trust’s particular case.

[Mr Angus Brendan MacNeil (Na h-Eileanan an Iar) (SNP)]

Any new money for health is, of course, welcome, but it has only come because of acute need in the English NHS. If there had been acute need in the Scottish NHS or further acute need in the Welsh NHS, we could whistle for it. Surely this is one reason for us to have full fiscal autonomy in Scotland so that we can control the spending and raising of money in Scotland rather than relying on mismanagement in England or on electoral advantage. What will be the consequences of this announcement for the Scottish NHS, the Welsh NHS and the Northern Irish NHS per annum?

[Mr Hunt]

I am very happy we devolve responsibility for the NHS to the devolved Administrations, because it means that people can compare performance and that we can learn from each other. For example, patients wait a shorter time for operations in England compared with in Scotland and Wales.

[Sir Tony Baldry (Banbury) (Con)]

Giving clinical commissioning groups the opportunity to commission GP services as well as secondary care will provide an amazing opportunity for there to be whole-population commissioning. Does it not also provide an opportunity for health and wellbeing boards? It provides an opportunity for elected councillors to work with clinical commissioning groups to try to design health care services, both primary and secondary, for the whole of the local population.

[Mr Hunt]

It absolutely does. My right hon. Friend makes his point very powerfully. This year, the better care fund—a programme derided by the Labour party, which said that it would not work—has been a huge success, with a £5 billion integration of the health and social care systems. The enthusiasm that that unleashed encouraged me to propose today that we should go further, so that where both parties are willing, local authorities and the local NHS should consider jointly commissioning public health as well. There would be huge benefits if they chose to do that.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Is it still the Government’s case that the emerging deficits across the English hospital trusts can be dealt with by efficiency savings alone?

[Mr Hunt]

There are huge pressures in the NHS. By the time of the election, we will have nearly 1 million more over-65s than there were at the last election. That means that people have to redouble their efforts to live within their means. At the same time people are trying to deliver the higher standards of care that we have talked about following the Francis review of what happened in Mid Staffs. It is challenging, but we expect all trusts to live within their budget. In all cases, they have recovery plans that we expect them to stick to.

[Sir Bob Russell (Colchester) (LD)]

I pay tribute to the medical and support staff at Colchester hospital for their work to bring it out of special measures. Twice the Secretary of State referred to focusing on prevention. May I suggest that a contribution to that admirable aim would be for first aid to be included in the national curriculum for schools?

[Mr Hunt]

No one campaigns more for first aid than my hon. Friend. I would certainly encourage all schools to teach first aid, as I think it is a very important skill and we should consider that as part of the prevention agenda. There is also a broader point, which is that we can do a lot with the Department for Education on this agenda.

[Derek Twigg (Halton) (Lab)]

In my constituency, people are increasingly finding it difficult to access GPs and the local hospital, Warrington and Halton, is in deficit and is missing its A and E targets. I therefore have a simple question for the Secretary of State. How many additional GPs will this money find, over and above the number of GPs who are in post today?

[Mr Hunt]

It takes seven years to train a GP, so the long-term solution is to train an additional 5,000 GPs, which is what the Government have decided to do and have announced. While they come on stream, this additional money will fund up to 20,000 additional posts, a number of which will be in the community.

[David Tredinnick (Bosworth) (Con)]

I congratulate my right hon. Friend on his emphasis on prevention. Has he had a chance to read Public Health England’s report “From evidence into action”? It encourages him to place greater emphasis on risk factors that contribute to an early death, such as tobacco, blood pressure, diet, inactivity and alcohol, rather than the actual conditions that people die from. That would cut demand for services.

[Mr Hunt]

That document is very powerful and I have said before that I hope that in our lifetimes this will become a smoke-free country. It is shocking that we still have 85,000 deaths every year linked to smoking. However, we are a free country so this is about supplying the information, incentives and nudges and not about compelling people.

[Fiona Mactaggart (Slough) (Lab)]

The right hon. Gentleman knows that GPs in my constituency have, on average, 4,500 patients on their list, which is about twice the average for England. Earlier he told my hon. Friend the Member for Stockport (Ann Coffey) that in constituencies such as hers and mine, where funding is so far from the target, we have to depend on NHS England, not him, to remedy the gap. How can we influence NHS England? What pressure is he putting on it to get fair funding for every area?

[Mr Hunt]

The reason we decided to give that decision to NHS England—it is now decided at arm’s length from Ministers—was to remove the worry people had that politicians might make these decisions for political purposes, rather than for what is right for the NHS. I encourage the hon. Lady to make representations to NHS England before its board meeting on 17 December.

[Charlotte Leslie (Bristol North West) (Con)]

I very much welcome the “Five Year Forward View” and the new investment, but does the Secretary of State agree that it is not so much a five-year forward view we need as a 20 or 50-year forward one, if we are to begin to meet the tsunami of demand we face? We will have to work together across the House as we face the tough questions on how to fund and manage the NHS. Otherwise, we will be accused by future generations of bickering while our NHS burns.

[Mr Hunt]

I hear what my hon. Friend says, but it is also important to have a clear plan of action to take us in the right direction over the next six years, which is what the plan from NHS England and Simon Stevens provides and what the Government have said we support. She is right that the demographic trends will get worse. By 2030 the number of over-80s will have doubled to 5 million. That is the sobering reality that we all have to face up to.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is the Secretary of State aware the some of us on the Opposition side feel a bit sorry for him? This is the third “pie in the sky” statement we have had recently—we have heard statements on rail, on roads and now on health—which basically say that things might get better in future, and of course the election is in five months. The fact of the matter is that when I go back to Huddersfield, I see a health service in which all the players, who used to work together in partnership for something they believed in, are now at each other’s throats, as a result of his reforms: not collaborating, but fighting, disagreeing and making bids against each other.

[Mr Hunt]

Let us take one example. The better care fund has meant that for the first time—this did not happen in 13 years under Labour—local authorities are sitting around a table with the local NHS, working out how to jointly commission care for the most vulnerable patients in the community. That is a huge step forward. The hon. Gentleman should talk with the people in his local authority, because he will hear about the incredible progress that is being made. This is not pie in the sky; it is £2 billion of new money for the NHS. That will make a big difference to doctors and nurses in Huddersfield, just as it will everywhere else.

[John Stevenson (Carlisle) (Con)]

I welcome the announcement of additional funds for the NHS and give my support to the Minister for putting patients first and driving up the quality of care. However, does he agree that it is not all about money and that quality, committed and motivated staff are central to a successful NHS, as is good leadership and management, particularly at the local level?

[Mr Hunt]

My hon. Friend is absolutely right. For every hospital in difficulty—he has had many discussions with me about his hospital, which is going through a very difficult period—there is another with the same funding settlement that is able to deliver good care with motivated staff. Leadership is extremely important for motivating staff, and the one thing that staff say matters most to them is having leaders who listen to what they say and, when they have concerns, take them seriously. That is a change that we are beginning to see throughout the NHS.

[Mr David Anderson (Blaydon) (Lab)]

On that subject, I can advise the Secretary of State that last week I spoke to nurses in the hospital near my constituency, and they told me that as a result of the cuts in their pay, which have been going on for many years, they are seriously considering setting up shoebox collections to help their members get through this Christmas. At the same time, the chief executive of that trust has had a 17% pay increase, and the governors have had an 88% increase in their allowances. Is that what he means by all being in this together?

[Mr Hunt]

I am afraid we will not take any lessons from the party that increased managers’ pay at double the rate of nurses’ pay when in office. I will tell the hon. Gentleman what this Government have done: because of our increases in the tax-free threshold, the lowest paid NHS workers have seen their take-home pay go up by £1,000 a year.

[Mr David Nuttall (Bury North) (Con)]

Despite all the claims and counter-claims, does the Secretary of State agree that in the long term, with a taxpayer-funded NHS, Government will only ever be able to increase resources and meet the public’s expectations if UK plc is thriving and we have a growing economy?

[Mr Hunt]

My hon. Friend is absolutely right. The Labour party thought it would win this argument by pledging extra money for the NHS at its party conference, but that will not actually happen until the second half of the next Parliament and it may not happen at all if it has got its sums wrong. The public reaction was simply not to believe it, because they know that what Labour does to the economy actually puts all NHS funding at risk, which is something we must never allow to happen.

[Mark Reckless (Rochester and Strood) (UKIP)]

Earlier this year, the Secretary of State announced a welcome £6.12 million grant for Medway, and on Tuesday he referred to the extra doctors and nurses being taken on in a special measures regime for Medway hospital. Could he assure us that extra and recurring funding will also be available to cover the costs in future?

[Mr Hunt]

The funding I have announced today—the £1.5 billion for front-line NHS services—is recurring, as is the additional Treasury funding of £1 billion. That is being added to the NHS baseline so that it can be invested in long-term increases in staff numbers, among other things.

[Mr Mark Spencer (Sherwood) (Con)]

What impact will the extra money have on hospitals in special measures, such as the Sherwood Forest Hospitals NHS Foundation Trust? Could he assure the House that any extra moneys will reach clinicians and patients and will not be swamped by the disastrous private finance initiative that the previous Government signed?

[Mr Hunt]

Of course, that has been a huge problem for Sherwood Forest Hospitals NHS Foundation Trust. I have met the chief executive, who is doing a very good job in turning around the trust, but there are huge challenges. What doctors and nurses in failing hospitals or hospitals in special measures want to know is that they have a Government with a long-term commitment to the NHS and who will deliver the economy that can fund the NHS. They also want to know that they have a Government who will tell the truth about problems so that they get sorted out, which never used to happen before.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Last week, as chair of the all-party group on motor neurone disease, I took evidence from professionals and patients who had been promised that £14 million would be available for communication support from April this year. Not a penny has been spent yet on equipment or new staff. I took phone calls from people who are end-stage kidney diseased who are frightened by the announcement that kidney dialysis is to go from NHS England to clinical commissioning groups. Will the Secretary of State get a grip, make sure that the money that is there is spent, and stop the disastrous move of kidney dialysis to CCGs, which are not functioning?

[Mr Hunt]

With the greatest respect to the hon. Lady, I will very happily look into the concerns she raises, but what we are talking about today is more money going into the NHS because the Government got a grip of public finances and got the economy growing. That means more money for people with long-term conditions, including people with motor neurone disease. The hon. Lady should therefore welcome today’s announcement.

[Andrew Bridgen (North West Leicestershire) (Con)]

According to clinicians in charge of health care and budgets, this Government have done much to take the politics out of running the NHS. Will my right hon. Friend confirm that average productivity in the NHS has improved under this Government, and does he agree that, given the outrageous comments of the Labour leader, it is clear that Labour is happy to see the NHS used as a political football?

[Mr Hunt]

I think what the public find very perplexing about this is that the Labour party opposed reforms that mean we have 10,000 more doctors and nurses on the front line. Labour is now not welcoming additional financial investment in the NHS that means we will have even more doctors and nurses, and it does not recognise the fundamental point that affects the whole NHS, which is that, in employing those extra doctors and nurses, we have to back them with a culture of safety and compassionate care that we never saw under Labour.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Our NHS is indeed reliant on a strong economy, but we should note that the UK’s state deficit is the worst in the European Union at the moment and our state debt has more than doubled since May 2010. Can I take it from the Secretary of State that I can go back to the constituents of Middlesbrough South and East Cleveland and tell them that their acute hospital trust will have its £91 million deficit removed; that its PFI, which was opened up in the Major years, will be dealt with properly; that Hemlington, Park End and Skelton medical centres will stay open: and that minor injuries units in Guisborough and Brotton will remain open?

[Mr Hunt]

I warmly congratulate the hon. Gentleman on being the first Labour Member to say in this House that a strong NHS needs a strong economy. May I encourage him to transmit that message to those on his Front Bench, and perhaps to the shadow Chancellor, who might then understand why people in the NHS are backing this Government because they know that we will deliver a strong economy? I do not know whether we can do all the things the hon. Gentleman talked about, but we will have a better chance with the fastest-growing economy in the G7.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I thank the Secretary of State for his statement and for the support that he has personally given to Medway Maritime hospital in my constituency, including, at a meeting last week, a commitment of £5.5 million to increase its A and E capacity. Can he assure me that hospitals in special measures that have problems going back to 2006 with high death rates will be given extra resources from the funding announced today to ensure that they are turned around as quickly as possible?

[Mr Hunt]

I assure my hon. Friend, who has campaigned very hard to improve standards at Medway hospital, that, first, we want to support its doctors and nurses, who are more passionate than anyone about putting this difficult period behind them; and that secondly, I have no greater focus than on making sure that we do turn around these hospitals in difficulty. It is a challenging process, but the extra funds that I have announced today will benefit all hospitals, including Medway.

[Mr Jim Cunningham (Coventry South) (Lab)]

The Secretary of State has boasted about the numbers of doctors and nurses coming through on his watch, but that actually started on Labour’s watch because, as he has said, the process takes seven years. What proportion of this new investment in the national health service is to be invested in Coventry, particularly given the disparity regarding doctors’ surgeries and the loss of doctors?

[Mr Hunt]

The training may have started under Labour, but if we do not have enough money in the NHS budget, we cannot pay for these doctors and nurses. We can do that because we took a decision, bitterly opposed by Labour, to disband the primary care trusts and the strategic health authorities and to lose 21,000 administrators so that we could pay for 10,000 extra doctors and nurses, including in Coventry.

[James Morris (Halesowen and Rowley Regis) (Con)]

The achievement of parity of esteem between mental and physical health in the NHS is absolutely fundamental to its future. As the Secretary of State will know, the Government have a reasonably good record on moving towards parity of esteem. Does he agree that we need not only more investment in mental health services, but, more importantly, better commissioning and a change of culture towards viewing patients as a single whole?

[Mr Hunt]

My hon. Friend has campaigned incredibly hard on this issue. I totally agree that the key aspect is a change in the approach of commissioners. People with mental health needs often have physical health needs and different needs relating to gambling and alcohol addictions, for example, that are connected to their mental health problems. Unless all these issues are tackled together, we are unlikely to make progress. We are very proud to have enshrined in legislation parity of esteem as something that we must achieve in the NHS. Today’s announcement will help this to go further.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

Given that delayed discharges have reached a record high, what guarantee can the Secretary of State give that this money will not be paid for by further cuts to local government social care budgets?

[Mr Hunt]

The hon. Gentleman will have to wait to see what the Chancellor says on Wednesday about the Department for Communities and Local Government settlement. This Government have recognised that the fate of the social care system and the fate of the NHS are closely entwined, and that we cannot support the NHS at the expense of the social care system because the two go together. That is why we see close working with the Better Care fund.

[Robert Jenrick (Newark) (Con)]

As my hon. Friend the Member for Sherwood (Mr Spencer) highlighted, Sherwood Forest Hospitals NHS Foundation Trust remains in special measures. I know that the Secretary of State has taken an interest in this. The trust has many failings, but it also has one hand tied behind its back in the form of a particularly egregious PFI deal that takes up 16% of its budget every year. Is there anything he can do to review trusts that are in special measures and have particularly difficult PFI settlements?

[Mr Hunt]

I remember visiting Newark hospital with my hon. Friend before he was elected, and I know that he campaigns very hard on the issues facing the trust. I will happily take that issue away and look at it. It is worth saying that the doctors and nurses at that hospital are working incredibly hard to turn things around, and they have already made great progress.

[Andrew Stephenson (Pendle) (Con)]

rose—

--- Later in debate ---

[Andrew Stephenson]

Thank you, Mr Speaker; I am honoured.

I very much welcome the £2 billion of additional funding announced today. This morning, I was at Airedale hospital for the preview of its new £6.3 million A and E department, which will open to the public this Wednesday. Will the Secretary of State join me in paying tribute to all the hospital’s NHS staff and management, and its patients, who have been involved from the start of the process in making sure that the new A and E department, which is more than double the size of the old one, is now a reality?

[Mr Hunt]

I am happy to do so. It is an absolutely brilliant hospital. I was really impressed when I saw that it has integrated its IT systems with those of local GPs better than anywhere else I have seen in the UK, and it is now looking at integrating those systems with local residential care homes. It has a fantastic Skype system for patients who are vulnerable and have mobility problems. It is an amazing place, and my hon. Friend is absolutely right to draw attention to it.

[Mr Marcus Jones]

The previous Labour Government left my constituents with one of the worst health funding allocations in England. Despite the extra investment that this Government have put in, the issue still has not been properly resolved. Having heard my right hon. Friend’s advice earlier, I will be making representations to NHS England. Will he join me in supporting my constituents in getting a fairer funding deal?

[Mr Hunt]

I want everyone to have a fairer funding deal, and today’s announcement is significant in that respect. One of the reasons it has been difficult to help people to move closer to their target funding allocations is that the increases in the NHS budget have been only 0.1% every year, so we have not had the margins necessary to make changes. Precisely by how much, and where, we make those changes is a matter for NHS England, but I will happily refer my hon. Friend’s concerns to it.