Five Year Forward View

Jeremy Hunt 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.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend has welcomed this report, which says, among other things, that there have to be new ways of working and breaking down barriers. The Royal London Hospital for Integrated Medicine—part of the University College London Hospitals NHS Trust—which is about a mile away from here, is Europe’s largest public sector provider of integrated medicine. Will he go there and see its 13 care pathways, which use qualified complementary and mainstream practitioners, because then it will be clear to him how we can reduce costs in the health service and take the pressure off practitioners? Will he make that part of his package?

[Mr Hunt]

I congratulate my hon. Friend on finding every opportunity to promote integrated care. What the report says is that we need much more person-centred care. It welcomes the kind of models that we see in Tower Hamlets, where the new clinical commissioning groups, led by inspiring leaders such as Sam Everington, are carrying out social prescribing. GPs are actually prescribing social solutions to problems as well as medical ones. This report is a big stepping stone towards that type of integrated care.

[Liz McInnes (Heywood and Middleton) (Lab)]

In my constituency last year, 23,000 people were unable to see their GP within a week. What, if anything, will these plans do to address that crisis?

[Mr Hunt]

I welcome the hon. Lady to her place. This report says something with which this Government very strongly agree, which is that we need to reverse the shift that there has been over many decades of investment away from community care towards hospital care. It is really important that we focus on the role of GPs. We do not want to force all GPs to become employees of hospitals, but we would like to back them, so we have brought back personal responsibility for GPs for every single NHS patient as an important first step in that direction.

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

This is an important report, which must not turn into another political football. We should focus on what it says and make that the basis for a real debate about our NHS. There are 23 references in this report to mental health. Parity of esteem is an established idea, but it has not yet been incorporated into NHS practice, so we still have further to go. Does the Secretary of State agree that another area in which we need to go further is perinatal mental health, where the cost to society, to mothers and to generations runs into billions? If the NHS could do a bit more in that regard, it would make a big difference.

[Mr Hunt]

My right hon. Friend is absolutely right. We know that perinatal mental health problems have a big impact on the child as well as on the mother. This report says that we must stop looking at conditions such as mental health as separate to physical health conditions. We need to look at people’s whole condition in the round. If we start to do that, we will make the NHS sustainable by making the kind of investments that will bring down the overall cost of treatments. Putting mental health centre-stage in that approach will be an important part of our strategy.

[Mr Dennis Skinner (Bolsover) (Lab)]

The NHS has been a political football ever since the 1947 Government decided to take it under public control. The Tories fought against it then, and they have fought against it ever since. The important thing to remember is that this report does not commend the Government for carrying out their reconstruction of the health service, which has cost billions. What we did when we were in power for 13 years was increase the amount of money for the health service from £33 billion to £100 billion—a threefold increase in real terms. Had we continued with that approach over the past five years, people would not be dying of cancer because they had not been tested early enough. The Tories talk about all-party agreement, but it is high time that they understood that since 1947 the Secretary of State and his posh people on millionaires’ row have opposed the very essence of the health service, which is why it will be the biggest political issue at the next election. It will also help us to win and get this lousy mob out.

[Mr Hunt]

I think that is the kind of rhetoric that does the whole country a massive disservice. If the Government had the kind of views about the NHS that the hon. Gentleman talks about, we would not have protected its budget during the most difficult recession we have had since the second world war. We actually increased the NHS budget over that period, because we believe in the NHS. With regard to what he says about the report, the chief executive of NHS England, a former Labour special adviser, said this, and it is a fact: “Over the past five years, despite growing pressure, the NHS has been remarkably successful.” That is what Labour people are saying.

[Steve Baker (Wycombe) (Con)]

I very much welcome the plans for urgent and emergency care set out on page 4, in paragraph 10, which ought to produce a solution that could be welcomed in Wycombe hospital and more than 20 similar hospitals across the country. When the proposals are taken forward, will my right hon. Friend ensure that they are explained to people in such a way that they can have real peace of mind that urgent and emergency care will be there for them?

[Mr Hunt]

My hon. Friend, as ever, makes an important point. I do not think that we have been as good as we should have been in the NHS about explaining changes to urgent and emergency care, and people are understandably worried if they think that there is any risk that they will not be able to see a doctor in an emergency, which is what the NHS is there to do. I think that we now have a better blueprint for urgent and emergency care, but the report also recognises that it is not sustainable to say that all urgent and emergency care will always be dealt with in A and E departments. We have to find a way to improve the capacity of primary care and make it easier for people to see their GP so that we can reduce the pressure on hard-pressed A and Es.

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

Will the Secretary of State take on board the fact —I invite him to visit Calderdale and Huddersfield NHS Foundation Trust to have a look—that the reforms that his Government introduced have fragmented the health service? It is very difficult to find in the health service one common purpose or one common voice. The fact of the matter is that whether it is A and E closures or NICE—National Institute for Health and Care Excellence—prescriptions being handed down by GPs, everywhere I try to find an answer, instead of one voice, one team and one leadership, I find fragmentation and no real positive movement.

[Mr Hunt]

Let me try to reassure the hon. Gentleman. The reality is that those reforms, by getting rid of the huge bureaucracies of the primary care trusts and strategic health authorities—19,000 administrators—have allowed us to hire an extra 10,000 doctors and nurses. We are doing nearly 1 million more operations every year. I will write to him with the details, and I think that he will find that there are more nurses and doctors employed in his constituency now than there were before the reforms.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

May I thank my right hon. Friend for appointing me to be the Government’s pharmacy champion? What role does he perceive pharmacies playing in this, because I think that they are an important part of the whole NHS?

[Mr Hunt]

I had a very enjoyable evening at the pharmacy business awards last night. Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits. The single most important change—my hon. Friend and I have talked about this—is to make it possible, if a patient gives permission, for pharmacists to access their GP record so that they can see their medication history and ensure that they give them exactly the right drugs.

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

In the light of this report, is it still the Government’s case that the emerging English hospital trusts’ deficits can be dealt with by efficiency savings alone?

[Mr Hunt]

The Government believe that the NHS has to live within its means, as do individual hospitals. We recognise that that is challenging, and one of the reasons it is challenging is that in the past it has been too easy for hospitals trying to balance their books to cut corners, for example on nursing numbers in elderly care and dementia wards. We have a new inspection regime that has made it much harder to do that, which I think is a good thing, because it means that older people are getting the care they need. It also means a harder road to getting those deficits under control, however.

[Chloe Smith (Norwich North) (Con)]

Page 26 of the document refers to

“an equal response to mental and physical health”.

Despite my right hon. Friend’s good leadership on this topic, I suspect that the document’s authors do not operate an equal funding formula for mental and physical health. Can my right hon. Friend give me any guidance on that?

[Mr Hunt]

We are looking at the issue very closely, and I think that we have made very good progress. We have introduced maximum waiting time targets for some mental health conditions, which has never been done before, and we have made a clear commitment to applying those targets to all mental health treatment during the next Parliament. However, my hon. Friend is right: ultimately, we need to look at funding differently. We need to look at it holistically. We need to understand that it is a false economy not to invest in proper mental health care, because it will only make the overall costs to the system greater in the long run.

[Heidi Alexander (Lewisham East) (Lab)]

The Health Secretary will know that one of the biggest challenges facing the NHS is our ageing population. Thousands of lonely people are living in unsuitable accommodation and are not receiving the care that they need. What proportion of the NHS land that will be sold off over the next five years will be used to create more suitable accommodation for older people, and to create communities of care where they can be given the service and attention that they need?

--- Later in debate ---

[Mr Hunt]

The hon. Lady has made an important point. We would like more NHS land to be sold off for precisely those purposes.

There is a broader point to be made about housing, which is also important, and which I thought the hon. Lady was going to make. If we are to think about care in a more integrated way, we shall need to reform the NHS so that we look at people’s problems holistically, and that will include looking at their housing, which has a direct impact on their health. I think the structures that feature in the five-year plan begin to make such an approach possible for the first time, and I find that very exciting.

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

Does the Secretary of State agree that the key aim of our reforms is to support hospitals which have not been fully supported before? Medway Maritime hospital, which is in my constituency, had one of the highest mortality rates in 2005-06, but nothing was being done. I thank the Secretary of State for putting the hospital into special measures, so that it can secure the support that it needs to turn things around and my constituents can have an excellent hospital that delivers for them. I also thank him for visiting the hospital recently and meeting its excellent front-line staff, who do a great job.

[Mr Hunt]

I thank my hon. Friend for what he has done for Medway Maritime. That was a very good visit: I met both management and staff, and gained a better idea of the challenges faced by the hospital.

The report makes it clear that we must become much better at tackling variations in care. Never again must we have a system in which hospitals are struggling and delivering poor care, and that poor care is swept under the carpet and nothing is done about it. The Government have put 18 hospitals into special measures—more than 10% of all the hospitals in the NHS—and that has been very challenging. We have been accused by Opposition Front Benchers of running down the NHS when we have done it, but do you know what has happened? Six of those hospitals have now come out of special measures, and nearly all the others have improved dramatically. It is time that the Labour party got behind what is a really good inspection programme, based on openness, honesty and transparency about problems.

[Julie Hilling (Bolton West) (Lab)]

Bolton clinical commissioning group is putting mental health services out to tender, which seems to involve a cut of between a half and a third on the basis of current spending. Are such cuts in mental health services what the Secretary of State means by his vision?

[Mr Hunt]

No, and that is why the Government legislated for parity of esteem between mental and physical health. As I said earlier, we have introduced maximum waiting times for some mental health conditions, and we have focused on improving access to psychological therapies—IAPT—and on dementia. Anxiety and depression and dementia are two of the most common mental health conditions in respect of which we can make a real difference, and we are doing more all the time.

[Margot James (Stourbridge) (Con)]

May I remind the Opposition that the primary care trusts that the clinical commissioning groups replaced sat above primary care, and were remote from it? Let me give an example of how much more integrated the system is now. Our clinical commissioning group has joined our hospital to fund the opening of an urgent care centre, which will relieve pressure on accident and emergency departments and give more patients a chance to gain access to the hospital from primary care. Does my right hon. Friend agree that that is an example of integration, not fragmentation?

[Mr Hunt]

Exactly—that is precisely the point. This report has example after example of how the new structures—clinical commissioning groups—are integrating care. That is why it makes it so clear that it would be wrong to do what Labour wants to do, which is to repeal the Health and Social Care Act 2012 and to strip CCGs of their powers when they are providing precisely the integrated care that we all think is important.

[Nic Dakin (Scunthorpe) (Lab)]

Northern Lincolnshire and Goole Hospitals NHS Trust has made significant progress over the past two years, but it remains financially very challenged and in significant deficit. What, if anything, in these plans will help to remedy that challenging situation?

[Mr Hunt]

Two things. I have had a very interesting visit to Goole hospital. It was very impressive to see how it has responded to the special measures programme and how, as a result of the new inspection regime, which Labour Front Benchers tried to vote down, it has made real improvements in care on the front line for the hon. Gentleman’s constituents. Those at the hospital will be pleased to see that this report endorses the new transparent approach to dealing with variations in care. It also says that we need to continue with increases in real-terms funding for the NHS, which we only get with a strong economy.

[Andrew George (St Ives) (LD)]

The theme of integration is re-emphasised in this plan, but how can commissioners ensure that they achieve that integration if they are forced against their will to outsource many services and also fear that their commissioning decisions will be challenged for being anti-competitive?

[Mr Hunt]

They are not forced against their will to outsource. They make the decisions as to where they want to purchase services from, and they do so on the basis of what is best for patients. Just like the primary care trusts that they succeeded, they have to follow European law in the way that they do that.

[Alex Cunningham (Stockton North) (Lab)]

The growing funding gap over the next five years is a real cause for concern. Can the Secretary of State tell me whether, after five years of changing plans, scrutiny and prevarication, we will finally get approval from his Department and the Treasury for the new North Tees and Hartlepool hospital, or will I have to wait for my right hon. Friend the Member for Leigh (Andy Burnham) to approve it after the election?

[Mr Hunt]

I have met the chief executive involved and heard their case for that, and we are processing it as fast as we can.

[Sir Tony Baldry (Banbury) (Con)]

The Commonwealth Fund’s recent study of 11 national health systems, including those of Sweden, France, Germany and the United States, found that the NHS in England was ranked top for a safe, effective, co-ordinated, efficient, patient-centred care system. Against that background, is it not rather unedifying for Labour Members constantly to try to pretend that the NHS in England is in some form of crisis, particularly given the deplorable performance of the NHS in Wales, which is run by Labour? Would not the shadow Secretary of State do rather better to remember the words,

“Or how wilt thou say to thy brother, Let me pull out the mote out of thine eye; and, behold, a beam is in thine own eye”?

[Mr Hunt]

I welcome the King James Bible reference. The independent Commonwealth Fund report that my right hon. Friend mentions contained one very startling fact, which Labour Members would do well to remember when they go on about the NHS—when they left office, we were seventh out of 11 countries on patient-centred care, whereas this year, now that we are in office, we came top. That is a huge improvement in patient-centred care. Under the new Care Quality Commission regime, his own hospital, John Radcliffe, got a “good” rating, which is an extremely impressive result.

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

The ambulance trust in the north-east has quadrupled the use of private ambulances, increasing its costs, and South Tees Hospitals NHS Foundation Trust is in deficit. In my constituency, two urgent care wards and a minor injuries unit are to be closed. A medical centre in Skelton has been closed, a medical centre in Park End has been closed, and a medical centre in Hemlington is to be closed. Does the Secretary of State take any responsibility for any of these health services in my constituency or across England? Every single response we get from him, every single time, is that somebody else is to blame.

[Mr Hunt]

Not at all—I take full responsibility for the NHS. Given the pressures created by having nearly 1 million more over-65s than we had four years ago, and the fact that the Government have had to cope with the deepest recession since the second world war, I believe that the NHS is doing remarkably well, and this document gives it a blueprint for the future that we can all welcome.

[Bob Blackman (Harrow East) (Con)]

Under this Government, the number of young people taking up smoking has fallen dramatically to some 3% and the number of people giving up smoking has increased. I welcome that very good news. We can now aspire to a smoke-free Britain over the next five years. Personally, I would like to see the tobacco companies taxed out of existence, but is it not irresponsible to base future spending plans on the basis of a tax on companies that will cease to exist?

[Mr Hunt]

That is a very good point and I agree with my hon. Friend that we should aspire to a smoke-free Britain. We are making remarkable progress. The point the report makes—this goes alongside what my hon. Friend has said—is that we need to integrate our thinking about public health with our thinking about the services the NHS delivers. The better care fund has shown how it is possible to get excellent collaboration between local authorities and the local NHS for the delivery of social care. Transformational things are happening up and down the country right now. I would like to see the same thing for public health as well.

[Lilian Greenwood (Nottingham South) (Lab)]

Alcohol abuse costs the NHS in Nottinghamshire more than £55 million a year and cuts in social services are making the pressures worse, especially for emergency departments. Dr Stephen Ryder, consultant hepatologist at Nottingham University Hospitals NHS Trust, wrote to me recently to express his deep concern that the Government are not taking forward the introduction of minimum unit pricing. Why are this Government ignoring advice and clinicians and ducking the issue of dealing with cheap alcohol?

[Mr Hunt]

We are doing a number of things to tackle alcoholism. Alcoholism rates have continued to fall under this Government, so we are making good progress. The approach to alcohol is different from that to cigarettes, because responsible drinking is perfectly okay for a person’s health; it may even be good for their health, depending on which doctor they speak to. We want to be careful that our alcohol policies do not penalise responsible drinkers who may not have large salaries and worry very much about the pennies their shopping basket costs.

[Julian Smith (Skipton and Ripon) (Con)]

Women chief executives now lead every one of the three hospitals serving my constituency. We have to thank all members of the NHS for this report, but will the Health Secretary comment in particular on the role of women in delivering NHS change and development?

[Mr Hunt]

I am absolutely delighted to do that. The new hospital inspection regime we have introduced has shone a light on some outstanding leadership. One of the best examples is Basildon hospital, which had terrible problems, including blood-stained floors, blood on the carpets and syringes left lying around in wards. That failing hospital has been turned around by an inspiring chief executive, Clare Panniker, and in the space of just 18 months it has now officially been rated as a “good” hospital by the CQC. We welcome the brilliant leadership of a growing number of female chief executives.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

GP commissioners in Morecambe bay are doing exactly the kinds of things mentioned in the report by shifting their focus from primary care to prevention. They know, however, that all the things they could do will not come close to closing the £25 million deficit. The Government say that they have to close it, but doing so would decimate hospital services. Will the Health Secretary listen to our case about the special funding needs of the area?

[Mr Hunt]

I am very happy to look into that. I recognise that all clinical commissioning groups face very real financial challenges to balance their books. That is why the report is so important, because it says that we cannot go on like this for ever and we have to look at changing the model decisively. It addresses the three things that could give hope to the hon. Gentleman’s CCG: increased real-terms funding based on a strong economy; more imagination in looking for efficiencies; and innovation and technology. We are absolutely committed to doing those things.

[Charlie Elphicke (Dover) (Con)]

In my constituency Deal hospital was left under threat of closure. It has now been safeguarded. Our acute hospitals had a Care Quality Commission inspection to identify problems, which have been dealt with; they were not covered up. Dover hospital, which was wrecked, is now being rebuilt. Will my right hon. Friend take a forward view of his diary and consider reopening that hospital at the opening ceremony in the spring?

[Mr Hunt]

If I possibly can, I will be delighted to do so. This is the pattern in many parts of the NHS that we do not hear from the Opposition Benches—where there have been problems in care year after year, they are finally being addressed. In my hon. Friend’s constituency and the hospitals that serve it he will be seeing more nurses and more doctors being employed and giving a higher standard of care, particularly to vulnerable older people. That is the kind of NHS that we should all welcome wholeheartedly.

[Graham Jones (Hyndburn) (Lab)]

The Secretary of State talks about holistic care and a range of issues that affect people, but active participation in sport, recreation and cardiovascular activity is declining. In constituencies such as mine, that is a real problem. What will he do to integrate CCGs with district councils? He seems to be saying nothing about this.

[Mr Hunt]

In my earlier comments I spoke a bit about childhood obesity, which is a very important issue. I was the Secretary of State responsible for the Olympics, and as part of the Olympic legacy we set up the school games movement, which now has about two thirds of schools in the country doing Olympic-style games every year, and we have put an extra investment into school sport. We need to work closely with the Department for Education on this, and I agree that it is very important that we do so.

[David Morris (Morecambe and Lunesdale) (Con)]

May I invite my right hon. Friend to come to my local hospital and to my constituency to see what good works have been done in my area? A £25 million health centre has opened, we have a new walk-in centre that was opened by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). May I ask my right hon. Friend’s views on the talk about top-down reorganisation? [Interruption.] We walked into a shambles of an NHS after 13 years of Labour government and a debacle of a CQC policy that we had to reconfigure. What are his thoughts—[Interruption.]

[Mr Speaker]

The hon. Gentleman has had a very full tilt. On the whole, it is a good idea to face the House, rather than the Government Front Bench. We are grateful.

[Mr Hunt]

Of course I would be delighted to visit my hon. Friend’s constituency. Morecambe Bay hospital is one of the hospitals whose problems we are looking at in a way that should have happened before but did not. We are turning round that hospital. We are determined to do it and we want his constituents to have absolute confidence in the quality of hospital care they receive.

[Sheila Gilmore (Edinburgh East) (Lab)]

The Secretary of State told us that a strong NHS needs a strong economy, so I presume he is extremely worried about the fact that reduced tax revenues have led, on this Government’s watch, to higher borrowing this year.

[Mr Hunt]

That is why we continue to take the tough and difficult decisions—[Interruption] that keep this country on the right economic path and which are opposed at every turn by Labour. They told us that our economic plans would lead to a million jobs being lost—[Interruption.]

[Mr Speaker]

Order. The hon. Member for Kingston upon Hull East (Karl Turner) keeps calling out “Ah!” as though he is sitting in the dentist’s chair. It is quite unnecessary. He can exercise his vocal chords later.

[Mr Hunt]

Perhaps the simplest thing is to say to the hon. Member for Edinburgh East (Sheila Gilmore) that we inherited one of the poorest performing economies in Europe. We now have the fastest growing major economy in Europe and that is the best possible future for the NHS.

[Mr Philip Hollobone (Kettering) (Con)]

The report makes it clear that with an increasing population and increasing proportion of elderly patients, the role of GPs will become even more important, yet the demographics of the GP profession mean that we will lose thousands of GPs to retirement in the next few years. What can be done to address this very important problem?

[Mr Hunt]

That is a very important issue and we need more GPs. We have about 1,000 more full-time equivalent GPs during this Parliament but we face the demographic issue that my hon. Friend identifies. That is why we are looking at how we can make it easier for GPs who have stopped practising, perhaps to have a family, to come back into the profession, and how we can make it easier for GPs to do part-time work. We are looking at all those issues because we are committed to reducing the burn-out that many GPs experience by improving and increasing the number of GPs actively practising.

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

General practitioner managers throughout the land will be tearing their hair out at the complacency of the right hon. Gentleman’s statement today. According to the patient survey, 39% of people could not see their preferred GP. That is an increase of 1.2 million. My general practice managers in Sale are saying that the situation is at crisis point. Why does the Secretary of State’s view differ from theirs?

[Mr Hunt]

As I have just told the House, I welcome a report that says we need to invest more in general practice. There has been historical under-investment over decades, which is why more and more resources have been sucked into the hospital sector. We are calling time on that and saying that we have to invest more in primary care, community care and out-of-hospital care. It is a big change for the NHS, and I think that the hon. Gentleman’s practice managers will be thrilled to hear it.

[Andrew Stephenson (Pendle) (Con)]

The Secretary of State may be aware that the excellent Airedale hospital, which he has visited, in the neighbouring constituency to mine, has been highlighted in “BBC News” coverage today, especially for its telemedicine service, as an example of what the future of evolving heath care may look like. Will he join me in congratulating the excellent staff at Airedale hospital on embracing change and pioneering new models of care?

[Mr Hunt]

I am delighted to do so. Airedale is mentioned in the “Five Year Forward View” as an example of how technology can be transformative. It has a system under which older people in the locality are given a red button, and as long as their TV is turned on, all they have to do is press the red button and they are talking to a nurse. That is immensely reassuring for them, and it means that they are more likely to stay healthy and happy and to live at home for longer. That is better for them and for the NHS, and it is a real model.