There have been significant improvements in the NHS and social care over the past 15 years in Cheshire and Merseyside. Survival from cancer and heart disease has increased, waits for some treatments are shorter and the quality of care is higher. More people are cared for in their homes and extra support has been provided to families with children. These gains have been achieved, despite global recession and austerity, thanks to efficiency improvements and the commitment of health and social care staff.

But there are major challenges ahead. 32% of the population live in the most deprived areas, with some of these people living shorter lives than in other parts of England.

We also have a higher than average number of people over 75. As the population ages, needs are changing, new treatment options are emerging and demand is rising. People are living longer, but not always healthier, lives. There are more frail elderly, more people with complex needs and more children, young people and adults with mental health challenges.

There is a rising burden of illness caused by smoking, drinking, obesity and similar public health threats. Fresh approaches are also needed to tackle mental health issues, teenage pregnancy and age related diseases like dementia and cancers.

These developments have put the NHS and social care under increasing pressure. A growing number of people with multiple problems receive care that is fragmented, confusing, or leads to wasteful duplication. Many people are treated in hospital when their needs could be better met in primary care or the community. There is too little co-ordination between NHS services, local authority services and the voluntary sector to provide care which meets modern standards and reduces variations in quality.

We also spend millions of pounds dealing with illnesses caused by poverty, stress, air quality, debt, loneliness, smoking, drinking, unhealthy eating and physical inactivity.

The challenge is significant; if we do not start to act now to radically change the way we do things, by 2021 more people will be suffering from poor health.

And the NHS alone faces a growing financial deficit which, on present trends, will rise to £1 billion in Cheshire and Merseyside by 2020/21 if we do nothing and which cannot be resolved without changing fundamentally how we work. And local authorities too are facing considerable financial challenges to maintain services. This demonstrates why change is needed, both in the way services are delivered and in the way the public use them.

We know that by working more co-operatively across organisations, publicly funded and publicly run health services, together with care services can provide local people with the highest quality care whilst reducing repetition, waste and unnecessary cost.