Variation in the way NHS England and its regional teams work with ICB leaders on acute management ‘underestimates’ their role in reducing demand, says a report published today.
The Hewitt review: where are we one year on?, an NHS Confederation report, looks at progress since former Labour health secretary and chair of Norfolk and Waveney ICB, Patricia Hewitt, conducted an independent review into ICSs in April 2023.
It highlights that ICB leaders have shared examples of being ‘by-passed by NHS England regional and national teams in the management of acute services’ which it says ‘underestimates the role of the rest of the system in reducing demand on services and improving discharge of patients’.
‘NHS England performance meetings focus almost solely on short-term issues at the exclusion of longer-term reform – both are crucial to NHS recovery and sustainability. This is also reflected in the draft oversight framework delivery metrics, which lean more heavily towards acute services than, for example, community and mental health services,’ the authors, Annie Bliss and Edward Jones, state.
They highlight that recent pressures and the ‘short-termist political climate’ have impeded ICSs, resulting in slow progress in implementing recommendations from the Hewitt review, such as streamlining data collation and reducing top-down micro-management to enable a focus on improvement in health outcomes.
Hewitt’s top recommendation was to move resources towards prevention but the report says while this has received attention from the Department of Health and Social Care (DHSC) analysis by the Nuffield Trust shows the proportion of NHS spending going into acute care has actually increased between 2016 and 2023.
The report is critical of the ‘several years’ it will take DHSC and NHS England to define and measure spending on prevention.
‘These steps are welcome, but the timescales risk slowing the pace of reform. A practical definition can and should be delivered much faster, informed by local definitions which have already been developed. This will be critical to supporting a shift in investment towards preventative services,’ the authors state.
To support greater local autonomy and improve outcomes, Hewitt proposed that each ICS be enabled to set local priorities and targets with equal weight to national targets. The report recognises that although ‘attempts to reduce the number of central programmes’ have been made, top-down performance management has ‘increased and is stifling the innovation and change needed to improve care and access to services’.
‘Publishing the 2024/25 national planning guidance just one working day before the start of the new fiscal year does not help systems to plan for the year ahead. This delay has led to a cycle of resubmitting, reviewing and editing plans during the year, which has drawn away time and capacity from delivering essential change,’ the report states.
It does highlight that some progress has been made towards embedding accountability arrangements in system oversight, establishing a national Integrated Care Partnership Forum to support cross-government working and providing a baseline to shift resources towards preventative services.
It also says that proposals set out in the Hewitt review were still overwhelmingly supported by ICS leaders and that it’s ‘still the right blueprint for the new Labour government to create the conditions ICSs need to reform public services and provide the best care for patients’.
