As discussed in our April 6th CF Snapshot, On 4th April 2023, the government published a report on findings of an independent review to consider how the oversight and governance of Integrated Care Systems (ICSs) in England can best support them to succeed. The report sets out a series of recommendations and focused around four critical themes:

1. From focusing on illness to promoting health
2. Delivering on the promise of systems
3. Unlocking the potential of primary and social care and their workforce
4. Resetting our approach to finance to embed change

For more details about the Hewitt Review, read our summary of the report in our snapshot.

Attendees:

To explore this further, this week we brought together leading experts on ICSs and contributors to the Hewitt Review in a roundtable discussion. The discussion identified and focused on three cross-cutting themes:

1. The practical importance of Data and Digital
2. What the review means by Productivity
3. The place and role of Leadership

The recommendations and themes within the Hewitt Review quickly comes back to the need for better availability and use of better-quality information in one of the most highly complex, but resolutely analogue, systems in the world. Good data and digital tools enable fast communication, proactive decision-making, clear accountability and empowered management. To enable the ambitions of ICSs and the NHS more broadly, smart and effective use of interoperable technology and high-quality data is crucial, and now urgent.

Chief Executive of North East and North Cumbria Sam Allen describes how she was struck by the collective enthusiasm and ambition from colleagues to making a step change towards a digital environment across health and social care. To truly harness the system’s potential to accelerate data development, we must ensure that change starts with the people and that they have timely access to quality data to navigate their journey in health and care.

Chair of Hampshire and Isle of Wight ICS Lena Samuels calls for the need to develop our data analytics and predictive capabilities in health and care leadership. The current NHS data infrastructure provides a retrospective snapshot of the big picture. However, now we must move to using data to anticipate future needs and proactively identify pressure points.

Chief Executive of North East and North Cumbria Sam Allen underscores the essential need to collaborate more effectively the commercial technology sector. We need to get more comfortable with partnerships between industry and health and care providers in an open-source way to draw on the best ideas, skills and technologies.

CF Managing Partner Ben Richardson explains the importance of data sharing between NHSE and ICSs to create a common view. Key issues around capital investment and information governance must be addressed to realise this opportunity.

Throughout the Hewitt Review, there is a spotlight on value: the interplay between Finance and Productivity. The discussion explored the necessary shift to understand and be clear about the types of value and efficiency the NHS is looking for including through new models of care and true value-based healthcare. A spotlight was also put on the need for ICSs to develop a long-term workforce and capital investment strategy to unlock the full potential of our health and care systems. The workforce strategy should include greater flexibility for staff to move between roles and be able to competitively recruit and train more specialists. We must reset our approach to finance to embed change, specifically shifting focus on prevention rather than treatment and addressing the inflexibility in use of capital and complicated allocations and approval. Much of this requires good data – and the need to ‘count the right things’.

Chair of Greater Manchester ICS, Sir Richard Leese, emphasises on the importance of value-centred investment and how that can be measured in three different ways: allocative efficiency, technical efficiency, and value to individual. He also encourages us look at other countries value healthcare models and explore how they can be adapted to the UK healthcare model.

CF Managing Partner Ben Richardson advocates the importance of counting and measuring the right metrics to allow providers to understand and compare their performances. A combination of good data, good system support and incentives must be in place to create an optimal value-based healthcare and must extend beyond acute and primary care into community and mental health.

Chair of West Yorkshire and Harrogate ICS Rob Webster asks where we should we look to reduce cost burden. He uses the example of the Paediatrics department in Leeds that focuses on family group conferences and restorative practice that has brought about transformative changes to the cost of delivering services to people with complex multi-factorial needs.

The Hewitt Review highlights that the success of ICSs relies on greater system autonomy and robust accountability to allow delivery at place, system, regional and national levels. Transparent organisational leadership is essential to encourage the cultural shift to take place to tackle system challenges by bringing together multiple organisations.

Chair of West Yorkshire and Harrogate ICS Rob Webster argues that central to the success of the transformative changes described in the Review, will be a reset of respect for each other among leadership across the various branches of the NHS and wider system organisations. Part of this will be to adopt a set of shared delivery outcomes and stand behind the national targets.

Chair of Greater Manchester ICS, Sir Richard Leese, reiterates the importance of a transparent data-enabled leadership culture for accountability across the system and out to the public they serve.