Health secretary Jeremy Hunt admitted to delegates at the NHS Confederation that his own party and politicians generally had been “guilty” of knee-jerk opposition to unpopular reconfigurations.

Questioned by conference delegates and the Today programme’s Sarah Montague on political support for reconfiguration, he said politicians and the NHS had “failed” to make the case for change in the past and that politicians had failed to back the service.

Mr Hunt told the conference “We [politicians] have a tradition of opposition [to reconfigurations].

“I hold my hands up that my own party has been guilty of this in the past.”

In 2007 then Conservative leader David Cameron promised the then Labour government “a bare knuckle fight” to save threatened district general hospitals.

In office then health secretary Andrew Lansley approved the downgrade of Chase Farm hospital after being pictured with the local MP at a “Save Chase Farm” rally.

Mr Hunt told delegates that while the current opposition members say they will support clinically-justified reconfigurations “in practice Andy Burnham and Liz Kendall “have opposed every reconfiguration that has been put on the table”.

He added: “I led a campaign to save A&E at the Royal Surrey. I think the argument has moved on a lot from those days.”

The minister’s comments came after being asked by Sarah Montague about the “20 hospital closures” line from the Academy of Royal Medical Colleges, NHS Confederation and National Voices report yesterday.

The Secretary of State said: “We do need to invest and we do need to change but if we say ‘we need to close 20 hospitals’ we will lose the support of the public.

“The reason we are so spectacularly unsuccessful in persuading them to downgrade is because they don’t have confidence in anything in-between [GPs and hospitals]. We have to be better at arguing for service change. Politicians have failed and the NHS has failed [at this].”

Mr Hunt also appeared to back the RCGP’s compromise proposal to make GPs accountable for a cross-section of the most intensive service users once they had left hospital, rather than everyone as originally planned.

He told the conference: “For the most vulnerable older people, who is the accountable clinician when they are outside hospital? For me as a member of the public I would like that to be my GP.

“We need to re-discover the concept of the family doctor.”

The Secretary of State was in combative mood when pressed over the 2004 GP contract, saying “I do think there were some fundamental mistakes in the GP contract. We broke the personal relationship [between doctor and patient].”

He objected to the phrase “picking a fight with GPs” from Montague saying, “What do you want me to do? Do you want me to not pick a fight? When every A&E I visit says they are under pressure because of the lack of [other facilities in the community] It is my job to argue for change.”

He added: “GPs work very hard but we have structures that don’t get the best out of them, we have made it very difficult for them to take a holistic view of the people on their lists. Do we need to address that? Yes we must.”