Read: Changing the model to change outcomes – the Hewitt review
Patricia Hewitt’s recent government-commissioned review of Integrated Care Systems (ICSs) is a response to the unprecedented challenges facing our health and social care system. There are clear reasons why now is the right time for a new approach - and it’s also clear that purpose-led NHS Trusts and health organisations - especially those already leading the way as members of the Purpose Health Coalition - will have a key role to play.
The most obvious challenges are the pressures that the entire system is currently experiencing – many evident even before the pandemic but undoubtedly exacerbated by it. Lengthy waiting lists, missed targets on A & E waits, ambulance response times and cancer treatment and industrial action all command the headlines but they are compounded by heightened public expectation as a result of advances in digital and data technology. There are also a growing number of people living with complex, long-term physical and mental health conditions, often associated with serious disabilities or ageing. Finally, the nation as a whole is becoming less healthy, both physically and mentally. More people spend longer in ill-health and die younger than they should, with the least economically advantaged and those affected by racism, discrimination and prejudice affected the worst. Health inequality is a growing problem and contributes significantly to the demands on health services in a cycle of disadvantage.
The Hewitt review has taken an independent look at the role that ICSs play, with the view that they provide the best opportunity for transforming our healthcare system, now and in the longer term. They are guided by four key aims – to improve outcomes in population health and healthcare; to tackle inequalities in outcomes, experience and access; to enhance productivity and value for money; and to help the NHS support broader social and economic development. They work through integrated care boards (ICBs), responsible for planning and funding most NHS services in the area, and integrated care partnerships (ICPs), which bring together a broad set of partners including local government, the voluntary, community and social enterprise sector, NHS organisations and others to develop health and care strategies for their areas.
The review has identified six key principles that are necessary for them to thrive and deliver their core responsibilities - 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.
It has recommended that there should be a change of focus away from illness and towards promoting health, with a shift in investment in preventative services that will enable people to live independently for as long as possible, build more resilient communities and reduce health inequalities. That will help tackle the fundamental causes of the current burden on the NHS and address the constant cycle of ‘winter crisis’ management.
The review also suggests a rebalancing of the health system - one of the most centralised in the world – by bringing people together in different ways to allow more local accountability and priority setting within the whole ICS. Government and NHS England should reduce the number of national targets and work through empowered place partnerships and neighbourhood teams. Each ICS should be able to set a number of locally-developed priorities or targets, as well as deciding the metrics for measuring them.
With recruitment and staff shortages crucial issues for the health service, the Hewitt report highlights the importance of building a sustainable, skilled workforce that will help unlock the potential of primary and social care and deliver the much-needed focus on prevention and early intervention. That means removing some of the barriers that currently exist, including the way in which the workforce is trained. ICBs will now have the opportunity to work with all elements of primary care to achieve the accessible and integrated services – including, for the first time, the commissioning of community pharmacy, optometry and dentistry - that residents and local communities need.
The review also concludes that current investment in the NHS is not creating the best health value. It suggests a reset, with an alignment of all national and local partners around health value, so that health and care is not seen solely as a cost but as adding a wider value to our society and the economy.
The Purpose Health Coalition supports purpose-led NHS Trusts and believes that they can play a major role in delivering many of these changes which will alter the way our health and care system operates. Adept at fostering constructive local partnerships as anchor institutions in their communities, and based on their local knowledge, our Coalition partners are already contributing to a more effective system. For example, amongst a wide range of work across the country, they are responding to the needs of very different coastal towns in Suffolk and Essex, tackling children’s dental needs in Stoke and supporting local people into lower-banded jobs in London. As part of the Coalition, they are already sharing best practice to demonstrate what is possible to other organisations and using evaluation and measurement as key tools in their efforts to track their progression in creating opportunity for the communities they serve.
With a new system model and an emphasis on prevention, ICSs can be the key to delivering sustainable, tailored solutions and to driving improved outcomes that will help to achieve improved health and wellbeing across the country and level up left-behind areas.
