The government has rejected the call for an increase in spending on prevention in its combined response to The Hewitt Review and Health Select Committee inquiry into integrated care systems (ICSs).
The review, first announced by Chancellor Jeremy Hunt in his autumn statement and published in April, called for a 1% increase in spending on prevention from NHS system budgets over the next five years.
The response, published yesterday, stated: ‘We do not agree with imposing a national expectation of an essentially arbitrary shift in spending’. But it added that the government agreed with NHS Long Term Plan, which says the focus for the NHS should shift over time towards implementing evidence-based interventions to help improve prevention and support healthier life expectancy.
It said that NHS England and DHSC will work with ICSs, local government and NICE to develop practical information and evidence to support local investment decisions including an ‘appropriate definition for preventative healthcare spending and exploring options for local baselining’ and will consider publication of this work when complete.
The response also did not endorse The Hewitt Review recommendation for 10 ICSs to become High Accountability and Responsibility Partnerships (HARPs) from April next year, which would see them have fewer targets and greater financial freedoms.
On targets, it said that there were areas of ‘national importance’ where targets will be set but that ‘there will also be areas where it is appropriate for local systems to set their own targets or areas where there may be a future national target where it makes sense for local systems to determine their trajectory of delivery against it’.
It said that the recognised benefit of the centre focusing on a small core set of priorities was demonstrated by the reduction to 31 national NHS objectives in the 2023/24 priorities. And it said that this would be reflected in the forthcoming mandate to NHS England.
It stated that ICSs will combine the NHS national targets from the mandate and the planning guidance with local priorities in the integrated care partnership (ICP) strategies. And ICBs’ joint forward plans would set out how both the national and local targets would be delivered in line with the ICSs’ four core purposes.
In response to the recommendation for a national mission for health improvement, it said: ‘We have established the Health Mission Working Group to provide a forum for working with other departments to explore opportunities for cross-government action to drive progress on the health mission and support common interests.’
On the recommendation to create a national forum for integrated care partnerships, it said that more work needs to be done to ensure there isn’t duplication. It added that details would be announced in the coming months.
Read the full response here.
