Independent review of integrated care systems

In November 2022, the government announced an independent review into the oversight of Integrated Care Systems (ICSs), led by former Health Secretary the Rt Hon Patricia Hewitt, chair of NHS Norfolk and Waveney ICB. The review is set to explore how best to cut through red tape and boost efficiency, financial accountability and autonomy with fewer national targets.  The objective of the review is to find ways to reduce disparities and improve health outcomes across the country by equipping the NHS to address issues such as reducing elective surgery waiting list backlogs and improving access to emergency and primary care.

The findings of the independent review are set to inform how best to empower local leaders to improve outcomes for their local populations, including giving them greater control and making them more accountable for performance and spending, reducing the number of national targets, enhancing patient choice and overall making the healthcare system more transparent. The review will focus on how national policy and regulation can effectively support and enable local systems to solve problems locally, building on the work already done by NHS England to develop a new operating model and overall create a system of regulation and accountability based on the principle that change should be locally led and nationally enabled.

Overall, the review will consider how the oversight and governance of ICSs can best enable them to succeed, balancing greater autonomy and robust accountability with a particular focus on real time data shared digitally with the Department of Health and Social Care and on the availability and use of data across the health and care system for transparency and improvements. In particular, the review will include consideration of:  

• The scope and options for a smaller number of national targets for which ICBs should both be held accountable for and supported to improve by NHS England and other national bodies, alongside local priorities reflecting the needs of local communities.
• How to empower local leaders to focus on improving outcomes for their populations, giving them greater control while making them more accountable for performance and spending.
• How to better monitor local performance and local targets set, with a focus on transparency.
• How to ensure new ICSs are held to account, both locally and nationally.
• The relationship between ICSs and central bodies (including NHS England and the CQC), as well as how the role of the CQC can be enhanced in system oversight.

On 18 January 2023, a letter was circulated by Patricia Hewitt revealing that there would be five work streams led by ICB, trust and local authority leaders, including ‘patient and service user groups, local government, the voluntary community faith and social enterprise sector and the social care provider sector, as well as the NHS’.

The letter adds that six initial headline ‘principles’ had been identified to drive the review, namely:

• Collaboration – including asking for more ‘joining up’ between the Department of Health and Social Care, NHS England and other national bodies to mirror the integration within ICSs.
• A limited number of shared priorities.
• Proportionate support for systems, meaning ‘less intervention for mature systems delivering results within budget and more intervention and support for systems facing greater challenges’.
• Balancing freedom with accountability.
• Enabling the use of timely, relevant, high quality and transparent data.
• Giving local leaders space and time to lead.

Ms Hewitt also criticised short-term and inconsistent policy interventions linked to non-recurrent small funding pots, often with complex rules and reporting requirements, which are frequently the result of government intervention. She states: 'effective change in any system – particularly one as complex as health and care – needs consistent policy, finances, support and regulation over several years. Adding new targets and initiatives... or non-recurrent funding makes it impossible to plan or even recruit, wastes money and time, and weakens impact and accountability. Multiyear funding horizons, with proportionate reporting requirements, are essential.'

A final report is expected by 15 March 2023.

Leila Souss

Anna Davies

Vincent Buscemi