Following the Chancellor's announcement in the Autumn statement, the Hewitt Review has now been published [4th April 2023], and considers how the oversight and governance of Integrated Care Systems (ICS) can best enable success while balancing autonomy and accountability. Patricia Hewitt is a former Secretary of State for Health, as well as Chair of the Norfolk and Waveney NHS ICB and Deputy Chair of its integrated care partnership.
This review comes soon after the publication a report from the Health & Social Care Select Committee, following its inquiry into Integrated Care Systems' autonomy and accountability. Among other findings, this report focussed on recommendations that would shift ICS targets to an outcomes based approach, create clearer mechanisms for measuring progress against these targets, and called for a focus on prevention and clarity on future funding to allow ICSs to plan. techUK welcomed these recommendations and the attention being paid to the success of ICSs, which present a once in a generation opportunity to rethink how we deliver care.
The report also comes on the same day as the announcement that £600m of funding for social care will be held back by DHSC. This funding, announced in 2022, included money for digital social care records and the better use of technology, and it is concerning to see funding allocated to digital transformation being withdrawn once again.
The Hewitt Review has identified 6 key principles that will foster an environment in which ICSs can thrive: 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.
Many of the recommendations made in techUK's policy report published July 2022, Right from the Start, align with and support the findings of this review, and there is significant scope for productive collaboration between the health and care technology industry, DHSC, and ICSs to ensure the recommendations are as impactful as possible. For example, the review suggests that the most effective ICSs should be used to trial a new model with more autonomy - techUK's recommendation of a national system for best practice sharing between ICSs would complement this scheme, helping to raise the standard within struggling systems.
ICSs have been born in difficult times. The answer is not simply more money, although of course that is needed, particularly in social care. Unless we transform our model of health and care, as a nation we will not achieve the health and wellbeing we want for all our communities - or have the right care and treatment available when it is needed.
Rt Hon Patricia Hewitt
The Hewitt Review: An independent review of integrated care systems
The review makes recommendations across four areas.
- From focussing on illness to promoting health
- The share of total NHS budgets at ICS level should increase by at least 1% every 5 years.
- The public health grant to local authorities needs to be increased
- To enable successful local integration, parallel integration across Whitehall is needed. The Government should oversee a national mission for health improvement, led personally by the Prime Minister, and establish a new Health, Wellbeing and Care Assembly
- Improving data interoperability should be a priority and the public need to be encouraged to make greater use of the NHS App to manage their own health.
- Delivering on the promise of systems
- The number of overall targets should be reduced, with a maximum of 10 national priorities
- NHS England should work with ICSs to deliver more autonomy
- The most effective ICSs should be encouraged to go further, working with NHSE to develop a new model with more autonomy
- NHSE and DHSC should incentivise the flow and quality of data between providers and systems
- Unlocking the potential of primary and social care and building a sustainable, skilled workforce
- There is a need for a national plan for the social care workforce, and flexibility between health and care staff should be created
- A new framework is needed for General Practice primary care contracts, as national contracts present a barrier to local leaders working in innovative ways
- There is a need to recruit and train specialists in data science, risk management, etc.
Here the review pays significant attention to digital, data, and technology, stating: “digital tools and Apps can play a vital role in enabling ICSs to improve population health outcomes”.
- The review specifically calls out the potential of virtual wards, fall prevention technology, support for out of hours clinical teams to respond to care homes and prevent admission, and wearables that empower people to monitor their own health.
- It recommends a longer-term ambition of establishing Citizen Health Accounts,requiring all health and care providers to publish relevant data they hold on an individual into an account outside the health and care IT systems, owned and operated by citizens themselves. This would enable people to proactively manage their own health and care, link to NHS app, and provide a gateway into clinical trials.
- Data and digital tools should be used to prevent ill health, and ICSs should be enabled to:
- Connect data from multiple sources to improve care outcomes and population health, tackle health inequalities, and improve wellbeing of staff.
- Work with NHSE and DHSC to develop a minimum data sharing standards framework to be adopted by all ICSs to improve interoperability.
- Put forward digital and data leaders to join the Data Alliance and Partnership Board.
- The review also states that the public must be empowered to manage their health via digital tools, meaning such tools must be inclusive and not exacerbate inequalities. For example, a high street pharmacy could work with ICSs to help someone into a digital consultation booth.
- Resetting our approach to finance to embed change
- NHS funding is too weighted towards treatment rather than prevention of illness
- Complex, uncoordinated funding systems mean that potential partners struggle to work with ICSs
- There is a need for a review into the NHS capital regime to address the lack of flexibility
- We should identify the most effective payment models, nationally and internationally, implementing a new model with population-based budgets,
The review's recognition that “instead of viewing health and care as a cost, we need to align all partners, locally and nationally, around the creation of health value”, is fully supported by techUK. We would urge the Government to work with health and care providers across the country, as well as with industry partners, to collaborate and implement the recommendations and in doing so improve health outcomes for UK citizens.
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The Interoperability Working Group will work towards achieving the vision set out in NHS England's 2022 draft standards and interoperability strategy. The group will aim to encourage the adoption of open standards and fluidity of data whilst recognising the commercial needs of members. It will also focus on demonstrating the value of interoperability to NHS senior management and improving the abilities of SMEs to implement interoperability standards.
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