The Hewitt Review: an independent review of integrated care systems

The Rt Hon Patricia Hewitt was commissioned to lead an independent review of integrated care systems in November 2022.

From:

Department of Health and Social Care

Published

4 April 2023

The Hewitt Review: an independent review of integrated care systems

PDF, 544 KB, 89 pages

The review set out to consider the oversight and governance of integrated care systems (ICSs). Each ICS has an integrated care board (ICB), a statutory organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. ICBs include representatives from local authorities, primary care and NHS trusts and foundation trusts.

The review covered ICSs in England and the NHS targets and priorities for which ICBs are accountable, including those set out in the government’s mandate to NHS England.

The government is now considering the recommendations made by the review.

NHS Providers responds to the Hewitt Review

Responding to the Right Hon Patricia Hewitt’s review of oversight and governance of integrated care systems (ICSs), Sir Julian Hartley, chief executive at NHS Providers said:

“At a time of great pressure across the health and care system, ensuring the right oversight, accountability and support for trusts and integrated care systems is critical.

“We welcome this report as it highlights how ICSs can help integrate care, forge partnerships within and beyond the NHS, and shift towards a preventative model of care.

“The emphasis on improvement over top-down performance management is essential and we hope the NHS at all levels will commit to the cultural shift necessary to bring this about.”

Further positive elements of the review include:

• the focus on prevention and health improvement as well as on the effects of inequality, racism and discrimination
• the recommendations for multi-year and recurrent funding, a review of the NHS capital regime and developing the social care workforce
• the recommendation to increase the public health grant allocation, which is central to enabling systems to drive forward their ambitions for the health of their local populations.

However, Sir Julian also 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.
“Likewise, while we support equal focus on waits for elective care and acute mental health treatment, we’re concerned that significant backlogs of care in the community sector are not highlighted.

“We thank Patricia Hewitt for the extensive engagement she undertook in producing this review, and for listening to trusts’ concerns and aspirations throughout. We look forward to continuing to work to support this review’s implementation.”