What is the Hewitt Review?
The Hewitt Review is an independent review of Integrated Care Systems (ICS) produced by the Rt Hon Patricia Hewitt, who was commissioned to produce this report in November 2022.
Key highlights
The Hewitt Review states that there are 6 key principles which will enable ICS’s to “thrive and deliver”. These principles are as follows:
- “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”
- “enabling access to timely, transparent and high-quality data”
The Hewitt Review has identified 4 elements which will support the principles above:
“From focusing on illness to promoting health”
- It will be key to move NHS budgets at ICS-level “towards prevention”
- To focus on “a national mission for health improvement”
- Establishing “a new Health, Wellbeing and Care Assembly”
“Delivering on the promise of systems”
- Focus on national and regional organisations to support ICS’s to become “Self-Improving Systems”
- Enabling further autonomy, giving ICS’s the “time and space to lead”
- Decentralising health and care systems via ICS’s
- Facilitating accountability with Care Quality Commission (CQC) and NHS England oversight
“Unlocking the potential of primary and social care and their workforce”
- Removing barriers around Primary and Social Care.
- Reconsidering how the health and care workforce is trained.
- Flexibility for health and care staff to be able to move across different roles and “delegation of some healthcare tasks.”
- Introduce a new framework for GP and Primary Care contracts to enable local leaders to work in “innovative and transformational ways.”
- Recruiting and training people in areas such as data science, risk management and system engineering.
“Resetting our approach to finance to embed change”
- To align partners, locally and nationally around a “health value” approach
- To tackle “over-complex, uncoordinated funding systems and rules in order to shift resource to where it is most needed.”
The King’s Fund have done a blog post breaking down the key elements of the Hewitt Review.
National Voices’ have also produced a blog on their reflections of the Hewitt Review.
Why does it matter to you and the VCSE sector?
The Hewitt Review acknowledges the role of the VCSE sector has in providing a more holistic perspective to health and care, and the value it provides in delivering support which enables people to remain well.
“In many parts of the country, partnerships led by local government, the VCFSE sector and residents themselves have been working over many years to create healthier, more resilient communities, often with strong engagement from NHS primary care. The response to the pandemic brought communities, statutory and voluntary partners together to support people in many inspiring ways.”
It focuses on prevention work and the key benefits of it to our health and care systems. It further highlights the need for a shared understanding of “prevention” and that ICS’s should move investment towards it (see above).
“We all recognise that ‘prevention’ involves a range of activity including primary, secondary and tertiary prevention, much of it carried out by local government and VCFSE partners as well as within the NHS itself. Furthermore, much ‘prevention’ work is embedded within other services that are also directly concerned with treatment. DHSC should establish a working group of local government, public health leaders, DHSC (including OHID), NHS England, as well as leaders from a range of ICSs, to agree a straightforward and easily understood framework.”
“ICSs themselves have the opportunity for health and social care professionals to learn from local communities, including VCFSE groups working with disadvantaged and marginalised groups, as West Yorkshire Health and Care Partnership is doing with its health inequalities academy and Cumbria and South Lancashire with their population health and equity academy.”
“Investment in prevention and early help is essential if we are going to extend healthy life expectancy, reducing the financial burden to health and social care and strengthening local economies.”
It recognises the importance of services which people and organisations want to see, notably, support that goes further than being medical, to encompass social and emotional wellbeing.
“Unless we transform our model of health and care, as a nation we will not achieve the health and wellbeing we want for all our communities - or have the right care and treatment available when it is needed.”
“partnership working, provides a real opportunity to build upon this approach and suggests a welcome recognition of the need for a more holistic approach to improving the nation’s health.”
“Designing and creating services together with local residents and communities leads to more actively engaged citizens, able to lead and support change within their own lives, with a corresponding reduction in reliance on public services.”
Overall, the Hewitt Review highlights elements which are pertinent to all organisations working in partnership with the ICS. Notably, we see here the importance of the VCSE involvement in prevention work and the opportunity we have to build upon the already innovative work we do within communities, further recognised by the ICS system and NHS England.
The key role the VCSE plays in providing joined up emotional and social support, further cements that the VCSE sector position as an equal partner within the ICS and as such, should be funded sustainably in order to meet the goals of the Review.
Holistic health and care places an emphasis on not just treating ill health, but further, the wider determinants such as housing, finances, and isolation. We know that the VCSE already has existing organisations which tackle these issues and is able to reach the communities which deal with these issues and those who are impacted by health inequalities.
Our North East and North Cumbria VCSE Sub-Groups, regularly discuss prevention work and what it means to them, as well as the importance of organisations working across sectors to create better health and wellbeing outcomes for their beneficiaries. So, how can we build upon and feedback into the Hewitt Review?
How can you feed into the Hewitt Review?
A message from Sam Allen, Chief Executive Officer of the North East and North Cumbria Integrated Care Board (ICB).
"The Government-commissioned review into Integrated Care Systems (ICSs) carried out by The Right Honourable Patricia Hewitt, has been published.
"We [the ICB] are encouraged that many of the themes and aspirations for the future discussed in the review report are also captured in the strategy for the North East and North Cumbria (NENC) ICS that has been developed collaboratively in the region, Better Health and Well Being for All.
"It's encouraging that we are well aligned to the recommendations of the review having widespread representation across our governance infrastructure. We therefore, welcome the review’s emphasis on increasing system autonomy as we know better decisions are taken when they are taken in our own health and care system.
"Our commitment to invest £13.6m in prevention every year for an initial three years was clearly the right decision, so too was our establishment of a learning and improvement system with a lens of continuous improvement. Both areas feature prominently in the review report.
"We will take time to fully consider the report and views will also be sought through our Area Integrated Care Partnerships and ICB members, to determine how it may influence the way we work. I'm also encouraging local authorities, Foundation Trusts, Health and Wellbeing Boards, the VCSE sector and professional associations to also discuss the review report within their own organisations and/or networks. We will be sharing the output of discussions/ engagement on the review report in the coming weeks and months. In the meantime, if anyone would like to express views separately, please feel free to email claire.riley22@nhs.net."
Additionally, there will be opportunities through the VCSE Partnership Programme, Partnership Forum and sub-groups, hosted by VONNE, to discuss and provide feedback. Any queries about how to get involved contact siobhan.flynn@vonne.org.uk.