The Hewitt review: where are we one year on? (NHS Confederation, 26 July 2024)

Summary

This long read explores progress against key themes in Patricia Hewitt's review of integrated care systems.

Content

Key points:

• It is now just over a year since the previous government’s formal response to Patricia Hewitt’s review of integrated care systems’ (ICS) autonomy and accountability. The proposals set out in the review are still overwhelmingly supported by ICS leaders and national partners as the right direction of travel to improve the population’s health, reduce health inequalities, improve patient care and get best value for money. Using integration, devolution, digitisation and shifting resources to prevent worsening ill health are essential to using resources more effectively and ensuring the long-term sustainability of the NHS.
• Only two years into statutory governance arrangements, it is still early days for ICSs. Changing the law does not immediately lead to the changes in services, behaviour and the ways of working that systems want to achieve. ICSs need time and structural stability to continue delivering reform.
• Some progress has been made towards aligning with the review’s principles and approach and in some cases implementing the review’s recommendations. For example, there has been some progress towards embedding accountability arrangements in system oversight, towards establishing a national ICP forum to support cross-government working and providing a baseline to shift resources towards preventative services.
• However, implementation needs to go further and faster. Short-term pressures and a short-termist political climate have impeded ICSs’ agency to drive change. Therefore, progress has been slow in implementing many important recommendations, such as streamlining and automating data collation; reducing the burden of top-down micro-management and reporting to enable a focus on longer-term improvement in health outcomes; and improving value for money by reducing use of small in-year funding pots.
• While the commitments made on the recommendations were under the previous government, following the UK general election ICS leaders believe the Hewitt review is still the right blueprint for the new Labour government to create the conditions ICSs need to reform public services and provide the best care for patients.