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Sir Merrick Cockell: To flourish in the future, the NHS must be integrated with social care

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.

Despite 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 everywhere.

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.


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