Update on the Government’s response to the Hewitt Review

The Hewitt Review was published on 4 April 2023 following the government announcement for an independent review into the oversight of ICSs led by former Health Secretary the Rt Hon Patricia Hewitt, chair of NHS Norfolk and Waveney ICB.

Several key recommendations were made as detailed in our previous article.

On 14 June 2023, the government published a positive response to the Hewitt Review, welcoming the Review and supporting the majority of the recommendations made (approximately only 6 out of 36 recommendations were rejected). NHS Confederation has also published an analysis in which it welcomed the government response, stating that it is a clear indication of its support for ICSs and a commitment to a model of devolved decision-making along-side appropriate accountability.

Of note:

• The government recognised the benefit of the centre focusing on a small core set of priorities, which has been reflected in the reduction to 31 national NHS objectives within the 2023 to 2024 priorities and operational planning guidance, and will be reflected in the forthcoming mandate to NHS England.
• The need to shift to a preventative model is supported, although the government rejected specific recommendations to increase the share of total NHS budgets at ICS level going towards prevention by at least 1% over the next five years. To support investment in prevention, NHS England and DHSC will work with ICSs and local government partners to develop practical information and evidence to support local investment decisions, including considering methodologies for developing an appropriate definition for preventative healthcare spending, amongst other things.
• With regard to creating High Accountability and Responsibility Partnerships (HARPs), the government supports the intent behind the recommendation and will undertake further work as ICSs mature to understand how it could be implemented in practice.
• The government supports the vision set out in the Hewitt Review in relation to the CQC’s enhanced role in reviewing ICSs, and will consider the best approach regarding ICS ratings, building on existing plans and development work led by CQC and including ratings on the quality of services within the ICS across key domains of care and ICS leadership.
• The government agreed in principle that systems should be provided with sufficient flexibility to determine allocations for services and appropriate payment mechanisms, particularly to meet the needs of their local population, but believe there are circumstances that warrant payment system incentives to encourage a particular activity; elective care, promoting value for money, and patient choice are all supported by common payment mechanisms.
  DHSC’s view is that significant opportunities to take account of local variation currently exist in the Payment Scheme, even where payment system incentives are used.

The Hewitt Review stresses that ICSs represent the best opportunity in a generation to transform our health and care system and emphasises the importance of achieving effective change through the combination of new structures and changed cultures. While the government’s commitment to the continued development of  ICSs is welcome, it is hoped that partners of all levels of the health and care system will commit to the cultural shift necessary to implement the ambitions and recommendations of the Hewitt Review, and in particular, a shift towards a preventative model as a core purpose of ICSs.  

If you require assistance with these matters or would like to understand how we can support you then please contact Anna Davies or Leila Souss.