Integrated care
The Hewitt Review: plans for integrated care
Kate Woodhead RGN DMS discusses the findings of the Hewitt Review on plans for Integrated Care Systems. The Review identifies six key principles, which will enable the ICSs to thrive. However, it remains to be seen how much of the report and its proposals will be accepted by the Department of Health and Social Care.
The Hewitt Review reported earlier in April on the oversight, accountability and governance of the Integrated Care Systems (ICSs) that are recently formed and making their way into changing the way health and care are delivered. The legal frameworks came into being in July, last year, as the Health and Care Act 2022, so the review was commissioned to add some needed detail and to help along the new relationships that are being made as the systems bed-in. Patricia Hewitt is a previous Health Minister in the New Labour government and is currently chair of the Norfolk and Waveney ICS. As part of the Review, she consulted widely, including all the 42 ICS organisations, as well as a comprehensive range of leaders from across the NHS in both acute, primary and mental health, local government and many other stakeholders with an interest. The timing of the new organisations and
development of key relationships may be said to be in the eye of the storm, while there is such turbulence around health and social care. The backlog of care is keeping clinicians very
busy, and there are unprecedented shortages of staff across primary, secondary and social care organisations. This does not help the development of new organisations and their delivery mechanisms, not to mention the spectre of continuing strikes which affect everyone, including patients and staff. The focus of the ICSs is to deliver on their four main statutory purposes: improving health outcomes and services, reducing health inequalities, delivering a financially sustainable health and care system and supporting our communities’ social and economic development.1 The Hewitt Report seeks to identify how the integration and collaboration changes can work to deliver them and all in a suitable governance framework, while enabling leaders the freedom to innovate. The Review2
identified six key principles which
will enable the ICSs to thrive and deliver: l Collaboration within and between systems and national bodies.
l A limited number of shared priorities.
l Allowing local leaders the space and time to lead.
l The right support balancing freedom with accountability.
l Access to timely, transparent and high-quality data.
l A move from focusing on illness to promoting health.
Governance of equals One of the aspects of the review is concerned with changing the top-down culture of healthcare performance management, to one of being in collaborative relationships with national and regional bodies. The ambition is for the ICSs to become ‘self-improving systems’.3 The complexity of the system, currently, is that management and scrutiny are led by NHS England with little flexibility and a wealth of targets. Hewitt suggests that the number of targets should be vastly reduced and should be limited to no more than ten. This would enable ICSs to prioritise resources on the needs of their local populations. The review calls for a re-set of the present
hierarchy between providers and NHS England. It is suggested that local priorities are given equal weight to national targets. The NHS Operating Framework, which is at present being updated, should take these re-balances into account. However, as this is also a governance review,
the report advocates: stronger local and mutual accountability within systems, underpinned by timely transparent data; a national peer review offer; CQC assessments looking at how systems are creating cultures of learning and improvement; and an explicit role for overview and scrutiny committees.4
Culture and behaviours There is a huge shift highlighted by the Hewitt Review in the way that organisations relate to each other. These trusting relationships between partners will not be made overnight
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