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.
It 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.