The independent review of Integrated Care Systems (ICS) by the Rt Hon Patricia Hewitt calls for a shift in resources, widespread change and acceptance of new structures, and the destruction of barriers that still exist between primary care and social care, including a new approach to training the health and care workforce.
The review drew on insight of leaders from across the NHS, local government, social care providers, the charitable and voluntary and social enterprise sector, looking at how best to empower local leaders to focus on improving outcomes for their populations. Organisations representing patients, as well as experts in academia and think tanks, also fed into a call for evidence that received more than 400 responses.
“We are currently not creating the best health value that we could from investment in the NHS,” the review states. “Instead of viewing health and care as a cost, we need to align all partners, locally and nationally, around the creation of health value.”
The share of the total NHS budget at ICS level going towards prevention should be increased by at least 1% over the next five years. Cross-governmental collaboration will also be required, to embed a national mission for health improvement and the establishment of a new Health, Wellbeing and Care Assembly.
Six key principles are identified in the review:
• Collaboration within and between systems and national bodies
• Limited number of shared priorities - the government and NHS England should reduce national targets to no more than 10 priorities
• Local leaders should be allowed the space and time to lead
• The right support
• Freedom to be balanced with accountability
• Enabling access to timely, transparent and high-quality data.
In the report, Helen Whately MP, Minister of State for Social Care stresses that doing more of the same is not good enough. The traditional way of operating a health system where hospitals, primary care and social care are all separate and operating in siloes, does not work in a world where people are living for a long time with multiple health conditions. “We know that the determinants of health are much broader than just what happens in a hospital. They include housing, wider care and education. Joining up is an imperative, both for improving health outcomes and for having a sustainable, affordable health system to get what we want.”
Patricia Hewitt adds: “Integrated Care Systems represent the best opportunity in a generation for the urgently-needed transformation that we need in our health and care system. Everyone wants them to succeed. To fulfil their potential, however, we need not only to back our new structures, but also to change our culture. Everyone needs to change and everyone needs to play their part.”
The recommendations of the report are intended to help the health and care system to make the necessary changes. Ministers will review them in due course. “I hope ministers, NHS England and others will feel able to take them forward,” Hewitt concludes.
