The Commission warmly welcomes the Hewitt Report analysis and recommendations for the next stage of development of Integrated Care Systems to deepen and strengthen health devolution.
The Review quotes the Commission’s view that broad-based integrated care systems and local partnerships are the only long-term solution to creating a financially sustainable and successful NHS and social care system; improving the population’s health and reducing health inequalities.
The Commission has yet to formally agree its response but the central tenet of the Review - that the creation of integrated care systems, with their four purposes and a strong statutory framework for partnership working, provides the right way forward for increasingly joined-up NHS, social care and public health services – chimes with our view that there is a need for a more holistic approach to improving the nation’s health. Like the Review, we believe that the NHS has a crucial role to play in creating thriving places and that there should be a significant shift of NHS resources ‘upstream’ to support prevention.
The Commission has long advocated that robust accountability, both to local residents and to Parliament through NHS England and ministers is necessary and was therefore pleased to see the Review conclude that there is scope for significant change in the balance between the traditional ‘vertical’ accountability of the NHS and its ‘horizontal’ mutual accountability to local government and other local partners. Proposals for a limited number of national health and care priorities for ICSs to deliver against and that local ICS priorities should be treated with equal weight to national targets coincide with the Commission’s previously stated views.
The Review’s principles for ICSs also reflect the approach previously identified and promoted by the Commission and are worth repeating in full, namely:
- collaboration within and between systems and national bodies
- a limited number of shared priorities
- allowing local leaders the space and time to lead
- giving the right support nationally and locally
- balancing freedom with accountability
- enabling access to timely, transparent and high-quality data
Other specific recommendations by the Review that reflect the Commission’s particular areas of interest include proposals for:
- a broad-based national Health, Wellbeing and Care Assembly
- a cross-government National Health Improvement Strategy
- local ICS priorities to be treated with equal weight to national targets
- a system based on subsidiarity, autonomy and self-improvement
- a Strategic Alliance for Children and Young People in every ICS
- a new strategy for the social care workforce
- a new NHS financial framework to enable greater local accountability
- clarity on the oversight and accountability roles of CQC and NHSE
- new measures of ICS maturity to support development
There is concern that the lack of any formal response by Government suggests that the Review could be left to wither away. The Secretariat of the Commission believe some of the 36 recommendations are ’must do’ changes to be acted upon by Government. These are likely to include:
- Adopting the six principles of integrated care
- Implementing the new national architecture of a broad-based national Health, Wellbeing and Care Assembly and a cross-government National Health Improvement Strategy
- Setting no more than 10 national targets and giving local ICS priorities equal weight to them
- Supporting the development of Local ICS Outcome Frameworks within a National ICS Outcome Framework
- Creating a social care workforce strategy
In addition, it would seem essential that action by the Government should be taken forward with partners across the health and care sector on:
- Re-balancing local mutual accountability and national accountability for health policy and expenditure including that of all NHS Trusts in an ICS area
- Providing more budgetary power at the local level including more flexibility for local collaboration the alignment of budget and grant allocations to local government and the NHS
- How to to improve population health, and reduce pressure on our health and care system, through a shift in NHS resources towards prevention including to mental health early intervention, such as counselling and psychotherapy services
- Ensuring that systems address the health and care needs of people of all ages with learning disabilities
- Ensuring a strong voice at every level in the system for patients, people with lived experience of care and local residents.
The Hewitt Review is a really very important contribution to future health and care policy. It was unfortunate it was published during recess and without a Government statement. The Commission will publish its formal response shortly and very much hopes the Government will set out its proposals soon.
Phil Hope and Steve Barwick are on the secretariat of the Health Devolution Commission
