ICS Network’s support for the Hewitt review's proposals

Dear Secretary of State,

ICS Network's support for the Hewitt Review proposals

As members of the NHS Confederation’s ICS Network Board – the independent national network representing all 42 integrated care systems (ICSs) in England – we warmly welcomed your decision to invite Rt Hon Patricia Hewitt to conduct an independent review of ICS oversight and governance. ICS leaders across the country have worked closely with Patricia over the last three months to support this important review. As her report reflects, while there will always be a range of views on some issues, fundamentally there is strong and broad agreement on the overall direction of her recommendations. If implemented, they would offer a step change in enabling us to deliver ICSs’ four core statutory purposes: improving health outcomes and services, reducing health inequalities, delivering a financially sustainable health and care system and supporting our communities’ social and economic development.

ICSs were put on a statutory footing nine months ago. We are already making a difference, as the many examples of success referred to in this review confirm. While the Act created the necessary statutory structures, legislation alone cannot create the changes in culture, behaviours and attitudes needed for effective and lasting change. Greater autonomy for ICSs combined with the right support from the centre, greater transparency about performance and robust accountability including an enhanced role for the CQC will, together, enable ICSs to succeed.

ICSs bring together many different partners: local government, social care providers, the voluntary, community, faith and social enterprise (VCFSE) sector and many others as well as the NHS. We welcome the review’s recommendations for a similar partnership at national level, including across government.

Across our systems, places and neighbourhoods, the answers to improving health and tackling variation in standards will vary. One size does not fit all, but there are common themes captured in this review. We endorse the review’s six principles:

• collaboration
• a limited number of shared priorities
• giving local leaders space and time to lead
• providing systems with the right support
• balancing freedom with accountability
• enabling timely, relevant, high-quality and transparent data.

At a time when the health and care system faces unprecedented pressure, the review’s proposals would enable us better to prevent worsening health, reduce demand for services and make our health and care system more sustainable. We will seize the opportunity to go further and faster on our immediate and shared priorities in primary care, urgent and emergency services, elective diagnostics and treatment and mental health support and services. Empowered by these changes, our systems will enter next winter in a more resilient state than the last.

We welcome the commitment from government and NHS England to working in partnership with ICS leaders, reflected in the decision to commission the review itself and the collaborative approach from NHS England to developing the recent NHS Operational Planning Guidance. Continuing to work in this way, as the review recommends, will ensure that experience of the realities of system working inform policy so it is better able to translate into improvement and results on the frontline.

Integrated care systems are still new. The challenges we face need urgent action. We are therefore asking you to implement the review’s proposals as quickly as possible to help us to meet them. For our part, we stand ready to work with you to implement these changes and achieve the improvements in health, wellbeing and care that we are all united in striving for. We would welcome the opportunity for an early meeting to discuss this vital work.

Yours sincerely,

Dame Gill Morgan, Chair, NHS Gloucestershire ICB & Chair of the ICS Network

Cllr Tim Swift MBE, Chair, Leader of Calderdale Council; West Yorkshire ICP; and ICS Network Board member

Cllr Tim Oliver, Leader, Surrey County Council; Chair, Surrey Heartlands ICP; and ICS Network Board member

Simon Whitehouse, Chief Executive Officer NHS Shropshire, Telford and Wrekin ICB; and ICS Network Board member