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Tuesday 04 April 2023

MiP responds to the Hewitt Review of Integrated Care Systems in England

By MiP

Patricia Hewitt Norfolk ICB

In December 2022, Patricia Hewitt, former Health Secretary and chair of Norfolk and Waveney Integrated Care Board, began a review of the oversight, governance and accountability of integrated care systems (ICSs), jointly commissioned by the Department for Health and Social Care and the Treasury.

The final report, released April 4, proposes greater autonomy to enable ICSs to better prevent ill health, improve NHS productivity care, and a streamlined centre, focussed on fewer national targets and directives.

MiP submitted evidence to the review, informed by members in all parts of the NHS in England.

Responding to the Hewitt Review, Jon Restell, MiP Chief Executive said:

"MiP welcome Patricia Hewitt’s review and the recommendations set out. We believe our members, managers and leaders in every part of the healthcare system, will also welcome much of what has been proposed here and we will be consulting them further once they’ve had a chance to digest the report in more in detail.

Local leaders are best placed to make decisions about local health. Proposals to ensure these leaders can act on the interests of the local population, including on prevention, is welcome. This was framed as the primary aim of the review and we believe many of the recommendations take steps to achieve it. But this has to be backed up with adequate resource if we want to truly empower local leaders.

The headline recommendation of the review will be the call to scrap many of NHS England’s national targets – with Hewitt recommending an absolute maximum of 10 national priorities. This chimes well with the views of our own members, who were wary of scrapping national priorities in their entirety, but will welcome the additional wiggle-room fewer arbitrary targets provides. It’s important to not let the power of fewer targets get weakened by sub-targets or assurance work.

Moving to a stronger emphasis on local and regional targets, set and defined by ICSs in collaboration with local providers, should help focus priorities at this level of the system and could help pave the way to reduce regional health inequalities and lead to improvements of population health.

National targets have never been backed up with an allocation of funds and we welcome Hewitt highlighting this. It’s a reminder that asking local managers and leaders to do more with no extra resource is not good enough. It leads to burnout, lower morale and decisions based on ministerial want rather than local need. Additional resources are needed to equip local systems with the workforce and capacity needed to hit any national or local targets and deliver for their populations.

We support the recommendations around streamlining the access to funding for ICSs and providers. Moving away from multiple in-year small-pots of money with strict access requirements will be extremely welcome to local managers, who tell us that the process for securing this funding is often too difficult and time consuming to be worthwhile. Multi-year funding streams will enable local leaders to recruit, resource and plan ahead – something our members have long advocated for and will undoubtedly support.

It is disappointing that shortly before the release of this report, the government announced ICSs must reduce their running costs by 30% before 2025/26. We support Hewitt’s call to government to rethink this, as telling ICSs to essentially downsize by 30% while giving them more responsibility could result in unrealistic expectations and significant pressures on the ICS workforce. If government are committed to this reduction, we urge them in their response to the report to outline how they plan to implement Hewitt’s recommendations while simultaneously pushing through these cuts.

Too often, health policy focusses on treatment rather than helping people stay healthy for longer. Hewitt’s calls to prioritise prevention, backed up with investment, is welcome. This is urgently needed to support the long-term sustainability of the NHS and improve population health. This will take a joined-up approach, bringing together local government, the voluntary sector and all parts of the NHS. ICSs already have the foundations required to truly bring these sectors together, but they still require further support ensure this approach is made reality.

Whether a preventative approach is realised however, will be down to how serious ministers are in pursuing it. 

The NHS has far too long lagged behind comparative healthcare systems when it comes to good use of data. We welcome recommendations calling for the establishment of a joint framework for the DHSC, NHS England and ICSs to share and utilise data to inform health interventions. This must be backed up with adequate training and development opportunities to ensure strong levels of data literacy throughout the system, enabling local leaders to be confident interoperating and applying interventions based on data.

As the NHS increases its use of data to inform decisions at local levels, it’s imperative that work is done to build trust with the public. A data-driven approach will only work if there is public support, so steps must be taken to ensure any data held is protected and the public are continually engaged by local and national parts of the system to ensure they support and understand the benefits of this approach.

There are a number of strong recommendations here which we believe can lead to a more balanced health service, with clearly defined roles for each part of the system. Government must listen to this report and begin looking at ways of best implementing its recommendations. For it to be successful, it has to be backed up with sufficient resources, and funded transparently by government. It should be implemented in tandem with the upcoming NHS workforce plan promised last Autumn, to ensure each part of the system has the workforce required to achieve the report’s aims.

But we’ve been here before, an ambitious review with strong recommendations and serious policy implications. Ministers tend to sit on these reviews rather than act on them, but now more than ever we require action. MiP are ready to work with government and NHS employers to begin making these recommendations a reality."

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