Hewitt Review: hope and experience

The Review of Integrated Care Systems by Rt Hon Patricia Hewitt, Health Secretary in the Blair government and commissioned by the current Health Secretary, Steve Barclay, was published today. It is a very welcome report; the question now will be how and to what degree it is implemented.

The focus of the Review was on the 42 Integrated Care Systems (ICS) established last summer under the Health and Care Act 2022. Its Terms of Reference included greater empowerment (and accountability) for local ICS leaders, a reduction in national target setting and an enhanced role for the Care Quality Commission (CQC) in oversight of the system.

Local government is a key partner in the ICS; within our system of Kent and Medway, and in particular its Integrated Care Partnership (ICP), which I chair, the three statutory partners are Kent County Council, Medway Council and the local NHS or Integrated Care Board (ICB). The County Councils Network played an important part in the Review (acknowledged by Patricia Hewitt in her Foreword), as did its Chairman, Tim Oliver (Leader of Surrey CC). I was able to take part in a number of ICS and local government leaders' calls with Patricia Hewitt and her inclusive approach was clear.

I cannot claim to have yet fully read and absorbed an 88 page report, but its general approach was increasingly clear as the Review developed and is confirmed today. The Review identifies six key principles:

- Collaboration within and between systems and national bodies

- A limited number of shared priorities

- Allowing local leaders the space and time to lead

- The right support

- Balancing freedom with accountability

- Enabling access to timely, transparent and high-quality data 

These principles aim to deliver a shift from focusing on illness to promoting health, with a shift in ICS budgets towards prevention of at least 1% over 5 years; more freed up and autonomous local systems; reducing the barriers between primary and social care and developing complementary strategies for health and care workforces; and shifting the approach to finance to embed change.

These are good aims, and the Review is full of accurate and important assessments of our current situation, with its over-centralisation, its fragmented approach and the degree to which we are, and remain on a treadmill of dealing with pressures within the system rather than addressing the factors that make those pressures worse. For example: "We are currently one of the most centralised health systems in the world, and ICSs give us an opportunity to rebalance this."

The challenge now will be to deliver on this. One section of the Review has the title 'Why it can be different this time' and Patricia Hewitt recognises (not least from her own experience as a former Secretary of State) that prevention, integration,moving upstream and financial sustainability have long been national policy aims. Her contention - and this is a view that I have argued in our debates on the ICS at County Council - is that strong cross-party support for ICSs, building on the experience of recent years, gives the opportunity to truly do things differently. 

Let us hope so.