Patricia Hewitt’s review of the powers of Integrated Care Systems could be seen as “ideologically motivated” by many NHS managers, MiP has warned, and must “strike the right balance” between local autonomy and national control. 

Former Labour health secretary Hewitt (pictured) is to lead the urgent review which ministers have signalled could hand more powers ICSs in England and loosen the grip of NHS England over how local services are run.

The review, ordered by Chancellor Jeremy Hunt and announced during November’s Autumn Statement, will examine the role, powers and accountability of England’s 42 ICSs, “with a view” to giving them greater autonomy, reducing the number of national targets and making local leaders more accountable for performance and spending.

MiP chief executive Jon Restell warned that many MiP members would be “suspicious” about the real motives behind the review. Recent ministerial briefing to newspapers about a “bonfire of NHS bureaucracy”, had lead many NHS managers to believe the review is “nothing more than an ideological witch-hunt”, he said. “If this review is to be successful it must leave out the politics and focus on the staff and patients.”

He urged the review team to “strike the right balance” between local autonomy and central direction. “We saw during the height of the pandemic that giving local leaders more autonomy can bring fresh ideas and better outcomes,” he added. “But, as a publicly-run, national service that’s delivered at a local level, the NHS needs a strong centre to operate effectively. This ensures local systems can deliver care without the constant threat of political pressure and intervention.”

Review chair Patricia Hewitt was health secretary from 2005 to 2007 and is now chair of the Norfolk and Waveney Integrated Care Board. She is expected to produce interim findings as soon as Christmas, with a final report due in March 2023.

Hunt, who was health secretary for six years until 2018, has frequently advocated restructuring the NHS along the lines of the education sector – with fewer central targets and more local autonomy. It has been reported that the review will look to scrap many of the targets and indicators used by NHS England and the Department of Health and Social Care to monitor NHS organisations, but that headline targets, such as those for waiting lists and ambulance response times, will not be affected.

Health secretary Steve Barclay is also on record as saying he wants to slim down NHS England and other arms-length bodies. He welcomed the review, claiming that “fewer top-down national targets and it remains to be seen at this stage what the review will mean for these organisations.

Hewitt review: MiP survey

MiP is carrying out a survey of members in England to gauge their views on the Hewitt review. The results will inform the union’s evidence to the review, due to submitted in January 2023. Check your email inbox for your invitation (email us at info@miphealth.org.uk if you can’t find it). The survey closes on 6 January 2023.