Councillor Sir Merrick
Cockell is Chairman of the Local Government Association. From April 2000 to May
2013 he served as Leader of the Royal Borough of Kensington and Chelsea. He is Deputy Chairman of the London
Pension Fund Authority and Chairman of the think-tank Localis.

Screen shot 2013-07-05 at 07.03.48It is
putting it mildly to say that the NHS has been through the wars in the past
year. It has undergone the most significant restructuring in its history and
been set the ambitious challenge to find £20 billion efficiency savings. Its
status as the closest thing we have to a national religion has been rocked by
the Francis Inquiry into the systemic abuse and neglect of frail and elderly
patients at the Mid Staffordshire Hospital Trust. And, most recently, Health
Minister Anna Soubry has forecast that A&E departments may ‘fall over’ if
demand is not checked.

But despite
this, the NHS manages to provide high-quality and comprehensive services to a population
that is increasingly old, whose health needs are increasingly complex and whose
expectations are ever higher. We continue to do well in comparison with other
developed countries. Compared with Australia, Canada, Germany, the Netherlands,
New Zealand and the USA, the NHS was found to be the second most impressive
overall in 2010. It was rated the best system in terms of efficiency, effective
care and cost-related problems. It was also ranked second for equity and safe
care. However, in the categories of long healthy and productive lives (6th) and
patient-centred care (7th), the NHS fared less well.

everything, the NHS is holding up well. My view of how healthy it will be in
ten years’ time is less certain. I see two possible futures for the NHS and, in
both, the fortunes of the NHS and local government are inextricably linked. The
worst case scenario is that we continue along the path of current service
provision, in which the majority of resources go into treating largely
preventable conditions in hospital. This approach will quickly become
unsustainable and health and social care services will buckle under the twin
pressures of growing demand and shrinking resources, dragging the rest of local
council services down with them.

The more
optimistic future is that health and local councils work together with their
communities and providers to radically re-engineer our planning and service
provision, using the totality of public resources to focus on prevention, early
intervention and supporting people to maintain their capacity and independence.
The answer lies in integration, not at the margins of health and social care in
some beacons of best practice, but as the mainstream approach adopted

We already
have some practical examples. The tri-borough pilot – comprising Kensington and
Chelsea, Hammersmith and Fulham, and Westminster – has jointly commissioned
localised health and care teams to
make sure people at high risk of admission get the right care at the right
time. They expect to save around £50 million a year by reducing unplanned
hospital admissions by 25 per cent, care home placements by 15 per cent and
unnecessary outpatients’ appointments and A&E attendances.

Nationally, we
are working with the Government and health commissioners to dramatically step
up the scale and pace of integration. Our 
‘pioneers’ programme is seeking a first tranche of ten areas to work
across their local health, public health, care and support systems to achieve better
services, better outcomes for individuals and communities, and greater
efficiency. The national partners will provide tailored support to pioneers
over a three to five year period. In return, they will share and promote what
they’ve learned for wider and, I hope, rapid adoption across the country.

I am
confident that the NHS will reach its 75th birthday if it redirects
its efforts and resources towards early intervention, health improvement and
broad social support. My key message, therefore, is integration with social
care and other preventative support services is the only way that we can
continue to afford the NHS.

This article also appears in The wisdom of the crowd: 65 views of the NHS at 65, published to mark the NHS's 65th birthday today by the Nuffield Trust.