Government responds to the Hewitt review

On 14 June 2023 the Department of Health and Social Care responded to recommendations made in the Hewitt Review and the Health and Social Care Committee's report on autonomy and accountability in Integrated Care Systems (ICSs) in England.
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The Government has formally responded to two recent reviews of the autonomy and accountability of Integrated Care Systems (ICS): the Hewitt review published on 4 April 2023 and the Health and Social Care Committee's report published on 30 March 2023.

RCPCH provided evidence to the Hewitt review and responded to its publication.

In its response, the Department of Health and Social Care (DHSC):

  • Reaffirms its support for integrated care systems
  • Confirms that national targets will be reviewed and streamlined
  • Confirms there are no plans to refresh the NHS England Long Term Plan
  • Highlights that the upcoming Major Conditions Strategy will direct the prevention agenda for ICS.

While the Government agreed with both reports that there should be a focus on prevention, they rejected the specific recommendations to increase the proportion of funding for prevention, to set up a national mission for health improvement and to require ICBs to include a public health representative.

In many places, the Government response agreed with the principles expressed in the reports but not the substance of the recommendations.  

Other key themes mentioned were:

  • Accountability and assessment of ICSs - Integrated Care Boards (ICBs) are accountable to NHS England in how they discharge their statutory duties. Care Quality Commission (CQC) will assess ICSs as a whole system, and is working with NHS England to develop assessment criteria.  
  • Targets and priorities - The Government agrees with the Hewitt review suggestion to reduce the number of national priorities, and this is reflected in the new mandate to NHS England.
  • Prevention and promoting health - ICBs are instructed to take a ‘life course approach’ to reducing health inequalities, starting from pregnancy and the early years.
  • Finance and funding - Formal delegation of specialised commissioning will begin in 2024-25. A review of section 75 is underway to consider widening the scope of health services that can be covered by covering pooled budgets.

We welcome that the Government has reaffirmed its support for integrated care systems and agree these systems hold enormous promise, through partnership working, to improve the health and wellbeing of the population including children and young people.

However, we continue to be concerned about the move to reduce national priorities and targets. While we understand the importance of allowing systems to prioritise based on local need, clear national standards are still needed to ensure every ICS provides safe and high quality care to children.

All too often our experience is that when there is no explicit requirement to focus on children, children and young people services are deprioritised in favour of adult priorities. Clear targets related to children and young people, for example to close the gap between children’s and adult’s elective recovery, are the difference between driving improvement or children being forgotten.

The UK has the worst population health in Europe so we are disappointed that the Government has not accepted bolder recommendations to increase investment in and focus on prevention. Investment in improving health and wellbeing for children and young people is key to improving the health of the population. With the upcoming Major Conditions Strategy highlighted in the Government’s response, it is vital that this strategy considers the distinct needs of children and young people, and moves away from its initial focus on older adults and frailty to consider a life course approach.

In its response the Government communicates support for the spirit of the Hewitt review recommendations calling for better access to high quality data. The College again urges the UK Government to adopt a consistent child identifier to enable this for children and transform children and young people’s care.