Hewitt review: supporting integrated care systems to ‘thrive and deliver’

Patricia Hewitt’s review of integrated care systems (ICSs) in England published on 4 April 2023 sets out wide ranging recommendations on oversight and governance. This major review calls for high performing ICSs or ‘high accountability and responsibility partnerships’ (HARPs) to be given ‘significantly greater financial freedoms’ and ‘a light touch national accountability framework’ together with a ‘radical reduction’ in the number of national priorities limited to ‘no more than 10’. 

The Hewitt review weighs in at 89 pages and sets out 36 recommendations focused on six key principles that will create the environment in which ICSs can ‘thrive and deliver’:

• 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; and
• enabling access to timely, transparent and high-quality data

There are several positive elements to the review from the focus on prevention and health improvements to multi-year and recurrent funding and an increase in public health grant allocations.

In addition to recommendations on accountability and the CQC’s role on system oversight, it includes proposals on a new framework for GP primary care contracts and a strategy for the social care workforce.

Highlighted below are a few of the key ICS recommendations.

Enhancing the role of digital and data

• A minimum data sharing standards framework to be adopted by all ICSs
• Improve interoperability and data sharing across organisations
• Implement the proposed reform to the Control of Patient Information regulations
• ICSs to identify appropriate digital and data leaders from with ICSs
• Department of Health and Social Care and NHS England to “work with nominated ICS colleagues to conduct a rapid review of existing data collections to reset the baseline, removing requests that are duplicative, unnecessary or not used for any significant purpose. This work should be completed within 3 months.”

The role of the regulator

• NHS England and CQC should work together to ensure that as far as possible their approach to improvement is 'complementary and mutually reinforcing'
• As part of CQC’s new role in assessing systems, CQC should consider within their assessment of ICS maturity a range of factors (set out on page 58 of the report)
• Enhancing ICS local accountability through Health Overview and Scrutiny Committees (and, where agreed, Joint HOSCs) as System Overview and Scrutiny Committees

Financial freedoms 

• Greater financial freedoms and more recurrent funding mechanisms - ending the use of small in- year funding posts with extensive report requirements (set out at page 85)
• Accelerate the work to widen the scope of section 75 arrangements under the NHS Act 2006 to include the previously excluded functions such as the full range of primary care services and the review of regulations

Pause ICS running cut allowances 

• The required 10% cut in Integrated Care Boards’ running cost allowance for 2025 to 2026 financial year should be reconsidered before the Budget 2024

Supporting providers facing difficulties

• Integrated Care Boards “should take the lead in working with providers facing difficulties, supporting the Trust to agree an internal plan of action”

Next steps

The review explains that ICSs represent the best opportunity in a generation for that urgently needed transformation of our health and social care system. The findings have largely been welcomed from the across the system although there are some calls for greater clarity.

NHS Provider's chief executive, Sir Julian Hartley has expressed some concerns:  

"The review needs more clarity on the responsibilities and accountabilities of different system players.

"We worry that trusts and integrated care boards (ICBs) will struggle to work as equal partners while ICBs have day-to-day oversight of providers.

"We're also concerned that some recommendations could add complexity and bureaucracy – for example, with auditing prevention spending and reframing the role of local government oversight."

The review’s findings are now with ministers who will review the recommendations of this report “in due course”.

If you'd like to discuss the Hewitt review and what this means for your ICB, do get in touch with Charlotte Lewis and Rhian Vandrill.