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The Hewitt Review: A Case for Change?

“Achieving the ambitions reiterated in the Hewitt Review, and creating the conditions for ICS success will require sustained commitment from all partners across the health and care system and we at NHS England are committed to playing our part.”

Steve Russell, Chief Delivery Officer and National Director for Vaccinations and Screening, NHS England.

Essentially, The Hewitt Review advises how Integrated Care Systems should be run to create a more sustainable NHS.

The case for change: The Hewitt Review

With an end goal of preventing ill health and improving NHS productivity, the main objective of the review was to evaluate how to best enable integrated care systems (ICSs) to succeed by balancing greater autonomy and robust accountability.

Identifying six key standards for change, the review recommended the following principles that will support the long-term sustainability of the NHS and its patients:

1. 1: Collaboration between systems and national bodies, treating each other as partners with complementary and interdependent roles and creating mutual accountability.
2. 2: A limited number of shared priorities that provides local leaders with flexibility about how they apply priorities to their local circumstances.
3. 3: Give local leaders space and time to lead by avoiding adding new targets and initiatives that make it hard to plan, while wasting valuable NHS resources.
4. 4: Systems need the right support, with ICSs needing whole system support, rather than individual providers or sectors.
5. 5: Balancing freedom with accountability between authorities, local government and systems, including a new role for CQC as the independent reviewer of ICSs as a system.
6. 6: Enabling timely, relevant, high-quality and transparent data essential for integration, improvement, innovation and accountability.

Examples of change: Acute Provider Collaboratives

“We’re seeing Acute Provider Collaboratives crop up across the country, some seem to be working well, however, some seem to find it a struggle, which is understandable. It will be difficult for NHS Trusts to step up to the plate and start collaborating, as they’ve spent the past 20 – 30 years in a highly competitive survival mode.” Explains Brian Wells, Founder of Four Eyes Insight.

Like ICSs and ICBs, Acute Provider Collaboratives (APC) are designed to improve efficiency, sustainability and care for patients by combining several Trusts to work alongside each other, providing many similarities to the Hewitt Review and moving towards increased collaboration and autonomy for organisations.

Towards the end of last year, NHS Confederation invited provider collaborative leaders to respond to a survey on the development of their collaboratives, with an interesting 70% of respondents highlighting that they still consider themselves in the early stages of set-up.

Although it seems positive relationships are being established between APCs and ICBs, working in co-operation rather than a ‘top-down’ model, as suggested in the Hewitt Review, the main challenges faced are around workforce and resourcing and the time it will take to set up collaboratives properly.

One of the key principles in the Hewitt Review is to give local leaders space and time to lead by avoiding adding new targets and initiatives that make it hard to plan. This is crucial to the success of these collaborations between providers, ICBs and ICSs –creating new targets every few months will do more damage than good, leading to diminishing patient experiences and access to healthcare.

Compelling Narrative: Maximising Patient Safety

Demand and access to healthcare services often outstrip available resources within elective care. Four Eyes Insight’s recent work with an APC in South England shows that organisations working together can provide system-wide capacity, improve productivity and maximise patient safety.

Supporting the establishment of an Elective Hub with the APC, we’ve identified that when fully operational, the Hub will significantly impact the high-volume demand and capacity gap, and release capacity for more complex surgical activity in specialist sites including ENT and Urology.

An estimated overall capacity increase of approximately 4500 -5100 additional surgical day cases per year could be achieved – providing the collaboration of services is developed and maintained.

Having a compelling narrative for APCs, ICSs and ICBs should be at the heart of these collaborations, without them teams would lack direction, engagement, and affect morale.