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The Hewitt Review of ICSs released

By April 6, 2023No Comments

The former Health Secretary, Patricia Hewitt, has released her Government-commissioned review of the oversight, governance and accountability of integrated care systems (ICSs). The review was first announced during the Autumn Statement by Chancellor Jeremy Hunt.

The review drew upon the experiences of many working with or within ICSs to understand exactly what changes need to be made. As ICSs encompass stakeholders from several different sectors, owing to their intended ‘joined-up’ nature, a broad spectrum of views was obtained – from NHS leaders and local government to patient groups and local voluntary sectors.

Numerous recommendations are made, with health leaders said to be prepared to embed these changes to improve the system working. However, ultimately, implementation is dependent on Government adoption of the recommendations.

Important recommendations are as follows:

  • Fewer central targets should be set by Government to allow greater flexibility for ICSs to choose how best to allocate resources depending on local needs.
  • There needs to be a greater emphasis on prevention in health, with sufficient funding in place, to ensure the long-term sustainability of the UK’s health and care system. Total NHS budgets at ICS level going towards prevention should be increased by at least 1 per cent over the next five years.
  • The Prime Minister should lead a government national health improvement mission alongside other departments involved in setting the national health improvement strategy.
  • DHSC, the DLUHC and NHS England should align budget and grant allocations for local government (including social care and public health, which are allocated at different points) and the NHS, to ensure systems can better plan their local priorities over a longer period; an improvement on current small in-year funding pot usage.
  • Data should be shared more intelligently across the healthcare systems, including data held by NHSE on ICS’s performance, which should be shared with individual ICSs themselves.
  • There should be better collaboration between ICSs and the CQC to develop a long-term approach to systems inspections, while ensuring the CQC increases its skillset to to support successful development of ICSs.
  • The NHS App should be better utilised to become an even stronger platform for innovation. A national user group for the app should be established to ensure the public, especially those with lived experience, have an input in future developments.
  • Patient data more easily accessible to the individual through a suggested Citizen Health Account, would allow patients to take better control of their health. Interoperability with the NHS App and other sources, such as NICE updates, would also benefit this endeavour.

The review draws on six key principles: collaboration; a limited number of shared priorities, giving local leaders space and time to lead; providing systems with the right support; balancing freedom with accountability; and enabling timely, relevant, high-quality and transparent data.

It is greatly optimistic of the benefits of ICSs, if governed correctly, arguing that they represent the best opportunity for a generation to radically improve our health and care system. Institutional change is also said to be more important than just greater investment, as without fundamental behavioral change community health and wellbeing will not reach the desired level.

The review states that ICSs represent an incredible opportunity to transform health across the country in a more holistic way through increased collaborations between systems and an emphasis on local needs. Central NHS policy, while important, will itself not solve all complex health challenges across the country. As long as the Government is fully supportive in creating an environment where local leaders and partners are empowered to make decisions which best benefit their community, then aspirational progress can be achieved.


Natalie Creaney