RCPCH responds to the Hewitt review

In November 2022, the Rt Hon Patricia Hewitt was commissioned to lead an independent review of integrated care systems in England.
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This week (Tuesday 4 April) the independent review of integrated care systems has been published. Integrated Care Systems (ICSs) are partnerships that bring together local government, the NHS, social care providers, voluntary, community, faith and social enterprise (VCSFE) organisations and other partners to improve the lives of people who live and work in their area, in line with their 4 core purposes. These are to: 

  • Improve outcomes in population health and healthcare
  • Tackle inequalities in outcomes, experience and access
  • Enhance productivity and value for money
  • Support broader social and economic development

Some of the key recommendations in the review are:

  • A shift in focus from illness to promoting health including a shift in resources
  • Better data interoperability and more effective use of high-quality data
  • A significant reduction in the number of national priorities and targets
  • The development of a national Social Care workforce strategy to complement the NHS strategy
  • The development of a new framework for GP contracts
  • Giving systems more flexibility to determine funding allocations for services

In relation to children and young people the review reinforces the requirements in the Health and Care Act that ICS should ensure that both their strategies and Joint Forward Plans, set out how they will meet the needs of children and young people.

In response to the review, RCPCH VP for Policy, Dr Mike McKean said:

In the context of increasingly poor child health outcomes, this review of integrated care systems comes at an important moment. While there are elements that are positive there are others that are cause for concern. 

We firstly welcome the focus shift from primarily illness to promoting health and the mention of the importance of giving every child the best start in life to reduce health inequalities across the UK. For paediatricians, prevention is a key part of our work. We know all too well how powerful prevention and early intervention can be in childhood. 

The emphasis on improved exchange and effective use of high-quality data including Patient Reported Experiences and Outcomes is also positive. Too often improved care for children and young people is held back by a lack of data and efficient information sharing across services. The College again urges the UK Government to adopt a consistent child identifier to enable this and transform children’s care.  Additionally, it is important to have a set of harmonised terminologies which describe children’s need consistently and allow for data to be captured in an accurate way. To support this, we encourage the continued development and adoption of the SNOMED CT paediatric terminology.

More widely, we are concerned to see recommendations on dramatically reducing national priorities. While we understand the need for flexibility to allow individual systems to prioritise based on their local need, clear national standards are still needed to ensure every ICS provides safe and high-quality care to children across the country. Some ICSs are doing excellent work to prioritise children’s care, but all too often our experience is that when there is no explicit requirement to focus on children, CYP 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 health service recovery, are the difference between driving improvement or children being forgotten.