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Patricia Hewitt reaffirms new vision for integrated care

Following her recent Review into integrated care systems, Patricia Hewitt joined PPP for a breakfast meeting to discuss the future of UK health and care and how to develop the NHS into a ‘national wellness service’. PPP Head of Policy Dr Dean Thompson covers the key insights from the meeting.
Patricia Hewitt

In late 2022, the government asked former Health Secretary Patricia Hewitt to consider the current oversight and governance arrangements of ICS and the use and availability of data across the health and care sector. The review fulfilled these asks from government with an ambitious series of recommendations. These proposals come in spite of a political reality that limits government funding for the reforms to take place.

PPP’s breakfast meeting centred around four P’s: partnership, purpose, prevention and population health management. It is hoped that, using these principles, ICSs can finally shift the NHS from a sickness service to a wellness service, with public health a core consideration of all future policy – even beyond the delivery of health services. Indeed, it was stressed repeatedly that ICSs must not become another layer of NHS bureaucracy.

These nascent systems must leverage resources beyond NHS, including from local governments, VCSEs and broader public services beyond health and care.

However, bringing these resources and different cultures together successfully requires more than statutory framework. As was stressed throughout the meeting, each partner in integrated care, both at a national and local level, must reconsider its role in public health and examine its own organisational behaviour.


One such player is the Care Quality Commission (CQC), whose bird’s-eye view of the health and care system makes it vital to the future success of ICSs.


Increasingly, CQC will need to adapt into an improvement agency as much as an inspector of specific providers. The changing role of CQC poses a profound yet  fascinating question for the future role of the health and care regulator.




The collection, analysis, and dissemination of patient data across the NHS and the wider system’s use of digital technologies has a chequered past. Regardless, the relentless march of digital tech and the promises it holds for better public health and patient outcomes demands continued engagement. But as the Hewitt Review notes, such engagement requires significant ramping-up of data science and associated skills in the NHS broadly and within ICSs.


Recruitment in the NHS is a perennial problem that will only be replicated here. Without a solid recruitment and retention plan that’s backed-up with salaries and conditions competitive with those on offer in the private sector, we will, in no short time, be discussing the lack of data specialists.

A focus on prevention


There is worthy attention given within the Review to greater emphasis being placed on prevention rather than cure. The Wigan Deal, led by the Chair of PPP’s Population Health in Business programme, Professor Donna Hall, is cited in the Report as good example of this approach. ICS and their leadership should, according to Hewitt, be playing a leading role within their communities, designing, in cooperation with local leaders, the programmes that address health inequalities.

It is, however, rightly pointed out that such plans can only succeed if national regulation is supportive and Whitehall buy-in is achieved. How the multitude of differing local health improvement plans might be consistently assessed and financially supported by government is yet to be considered.


Redefined roles and responsibilities


From the outside looking in, the entire public health environment is a complex web of layered bureaucracy, roles and responsibilities. Perhaps it’s a view shared by those within the environment, too.


Hewitt rightly stresses the need for central organisations to reflect and mirror the integration and collaboration that is being implemented at local level. As such, the Review recommends various government agencies work together to form new “High Accountability and Responsibility Partnerships” (HARPs) commencing in April 2024. It’s envisaged that HARPs will form a type of devolved body for health policy. National priorities and Key Performance Indicators are replaced with local ones, with financial and resource responsibilities devolved to HARPs.


To manage the inevitable divergence in priorities and management, the Review suggests that consistent shared data sets are created to ensure health outcomes are being met, services are used efficiently and reviews undertaken on a six-monthly basis. The problems with this devolved approach may well replicate many of those encountered in other devolved policies. While powers and responsibilities are initially demanded, once granted, the actual skill and capacity to deliver often diverges from the intention. In turn, the gap between intention and reality manifests into a political fight over levels of funding to deliver and the regulatory framework in place.


What is clear from today’s discussion is that ICSs are here to stay. The 2021 Health and Care Act has created an effective development from STPs and, while they may not openly admit it, it is extremely positive that the main political parties are in broad agreement on the fundamental principles of ICSs.


We sincerely hope that the government will heed the Hewitt Review’s findings and provide local leaders with the tools they need to effectively guide their local health and care systems. ICBs must be allowed to develop locally responsive ambitions – facilitated by effective thought leadership from the centre and reflective regulation from the Care Quality Commission.



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