The Hewitt Review into Integrated Care Systems

Avid readers of the Landmark Health and Social Care Insight blog may recall David Lock KC’s article in the July 2022 edition, which confirmed that Clinical Commissioning Groups had been formally abolished by the Integrated Care Boards (Establishment) Order 2022, which was made under the provisions in the Health and Care Act 2022 (“the Act”).

This change paved the way for the establishment of Integrated Care Boards (“ICBs”), which were already operating in shadow form at that time. On 1 July 2022, NHS England established 42 statutory integrated ICBs. This change formed part of the Act’s provisions for creating Integrated Care Systems (“ICSs”). ICSs are partnerships of NHS bodies, local authorities and relevant local organisations that work together to plan and deliver health and social care services.[1] Each ICS has an ICB, which is a statutory organisation which brings the NHS together locally to improve population health and establish shared strategic priorities within the NHS.[2]

When these changes were first implemented, it remained to be seen whether they were just a further NHS rearrangement, unlikely to deliver any real change, or whether they in fact represented a material shift towards a more holistic and better integrated NHS. Whilst it’s too soon to judge the impact of the changes, an independent review into the oversight of ICSs, the Hewitt review, was announced on 18 November 2022 which may shed some light on the government’s ambitions for ICSs, and the issues facing them.

As the name suggests, the review is being chaired by the Rt Hon Patricia Hewitt, Chair of NHS Norfolk and Waveney Integrated Care Board and former Secretary of State for Health and Social Care.

On 6 December 2022, the Department of Health and Social Care published the terms of reference of the Hewitt review. The stated purpose of the review is to consider “how the oversight and governance of integrated care systems (ICSs) can best enable them to succeed, balancing greater autonomy and robust accountability”.[3] It will “cover ICSs in England and the NHS targets and priorities for which integrated care boards (ICBs) are accountable”.[4]

In particular, the review is tasked with considering and making recommendations on the following specific issues:

• “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”;
• “the scope and options for a significantly smaller number of national targets for which NHS ICBs should be both held accountable for and supported to improve by NHS England and other national bodies, alongside local priorities reflecting the particular needs of communities”; and
• “how the role of the Care Quality Commission (CQC) can be enhanced in system oversight”.[5]

The scope and terms of reference of the Hewitt review certainly suggest that the government has ambitions for ICS and ICBs to deliver substantive changes and, ultimately, a more holistic and better integrated NHS. However, what the Hewitt review’s findings and recommendations will be, and crucially, how they will be implemented in practice, remain to be seen.

The Hewitt review is running to an ambitious timetable, with a final report expected by 15 March 2023, so watch this space!

Harriet Wakeman is a barrister at Landmark Chambers. She specialises in public law, inquests and public inquiries. She is recognised as a ‘Tier 1 Rising Star’ (Legal 500, 2023) and an ‘Up and Coming’ junior (Chambers and Partners, 2023).

[1] https://www.england.nhs.uk/integratedcare/integrated-care-in-your-area/

[2] Ibid.

[3] https://www.gov.uk/government/publications/hewitt-review-terms-of-reference/hewitt-review-terms-of-reference

[4] Ibid.

[5] Ibid.