The Hewitt Review focuses on health promotion.
Working to a fast and furious timescale, the former Health Secretary Patricia Hewitt published her independent review of integrated care systems in April.
The review considers the accountability, oversight and governance of integrated care systems (ICSs). It also considers the role of national government and NHS targets and priorities, for which integrated care boards are accountable.
Though the timeline was extremely tight – the Chancellor announced the review in last November’s Autumn Statement – Hewitt’s team took an inclusive approach in developing the findings and recommendations.
More than 1,000 leaders from across the NHS, local government, social care, the voluntary, community and social enterprise (VCSE) sectors, think tanks and academics have been engaged.
More than 400 respondents, including the LGA, submitted written evidence.
Local government has been particularly well represented, with elected members and officers on each of the workstreams tasked with developing recommendations.
Cllr Tim Oliver, Chair of the Surrey Heartlands Integrated Care Partnership Committee, and a member of the LGA’s Community Wellbeing Board, and I were involved in working groups, as were several senior LGA officers.
Patricia Hewitt also attended a meeting of the Community Wellbeing Board, to hear the views of board members.
The result is that many of the LGA’s messages from our evidence are echoed in the final report. It is not possible here to summarise the almost 40 wide-ranging recommendations, but here is my take on the key messages.
A new focus on promoting health
The LGA has always strongly advocated for a far greater emphasis on, and investment in, prevention, so we are delighted that the Hewitt Review clearly reinforces this message.
It calls for an annual uplift of 1 per cent for the next five years in ICS budgets for prevention. It also calls on the Government to increase the local government public health grant.
“Local leaders need the freedom and flexibility to focus on the unique challenges of their populations”
Maximising the potential of ICSs and letting local leaders lead
Government and NHS England must give ICS leaders the time, space and appropriate support for them to get the best health outcomes for their communities.
Hewitt calls for a significant reduction in the number of national targets for integrated care boards to ‘no more than 10 national priorities’.
The report also highlights the importance of ensuring that decisions are made as close as possible to the communities they affect, with a strong role for place-based partnerships.
Greater local autonomy and accountability depends on the availability of timely, transparent and high-quality data shared by all partners.
The review makes several helpful recommendations about the need to maximise the use of shared data and to reduce the reporting burdens imposed by national government and agencies on local systems.
Unlocking the potential of primary and social care and their workforce
The review recommends far closer working to plan for, recruit and train the health and care workforce, with a national social care workforce plan to complement the soon-to be-published NHS workforce plan.
It also calls for more to be done to increase flexibility for health and care staff to move between sectors. There is welcome recognition of the urgent need for adult social care to be adequately funded.
A joined-up approach to funding across health, social care and local government
In the same way that ICSs bring together the NHS, local government, the VCSE sectors, and other partners to join up care and address the wider determinants of health and wellbeing, Hewitt calls on national government to adopt a joined-up approach between government departments.
In particular, the Department of Health and Social Care, the Department for Levelling Up, Housing and Communities, and NHS England should align budgets and grant allocations for local government, including social care, public health and the NHS.
What next?
My read out of the review gives just a small glimpse of its many messages and recommendations.
The work necessary to produce the report has been substantial, but it has resulted in positive and constructive recommendations.
The LGA strongly agrees that ICSs are a real opportunity for local NHS, political, professional and community leaders to do things differently and forge a new model of health promotion, care and support to improve the health and wellbeing of their communities.
This model reaches beyond the boundaries of the NHS and social care to address the causes of poor mental and physical health. It is one that also ensures that, when people do need support, they get the right care, in the right place and at the right time.
In order to deliver, however, local leaders need the freedom and flexibility to focus on the unique challenges of their populations.
National government needs to trust NHS and local government leaders to work with their communities to set their own priorities.
We will continue to work with partners to ensure that the Government acts to implement the recommendations of the Hewitt Review.
It is important that we all make the most of this opportunity for real and lasting change in our approach to improving the health of our communities.