Call for evidence outcome

Hewitt review: call for evidence

Updated 14 April 2023

This was published under the 2022 to 2024 Sunak Conservative government

Applies to England

Introduction

On 1 July 2022, integrated care systems (ICSs) were placed on a statutory footing, through the creation of

• integrated care boards (ICBs), which are statutory NHS bodies
• integrated care partnerships (ICPs), which are joint committees formed by each ICB and the relevant local authorities in the ICS area

ICSs bring together the NHS, local government, the voluntary, community and social enterprise (VCSE) sector and other partners to better integrate services and take a more collaborative approach to agreeing and delivering ambitions for the health and wellbeing of their local population.

The purpose of ICSs is to bring these partner organisations together to:

• improve outcomes in population health and healthcare
• tackle inequalities in outcomes, experience and access
• enhance productivity and value for money
• support broader social and economic development

The establishment of ICSs and the new statutory framework strengthen the move towards greater local accountability and collaboration. The result is that everyone involved in public health, healthcare and social care, whether locally, regionally or nationally, will have to work differently – empowering local leaders while also maintaining effective accountability for quality and outcomes.

As far as the NHS is concerned, within each ICS, the different elements of the NHS – including primary care, community and mental health services, acute and specialist hospital trusts, and ambulance services – are all involved in creating new partnerships. This will mean building partnerships with each other, with social care and many other partners within local neighbourhoods, and at place and system level.

This will require all the statutory bodies working with ICSs, including the Department of Health and Social Care (DHSC) and NHS England, to change the way they work within the statutory framework set by the Health and Care Act 2022.

NHS England, for example, is already making a significant cultural and behavioural shift to partnership-based working, as set out in its new operating framework. It is co-creating NHS policy, strategy, priorities and delivery solutions with both local system leaders and national partners. It has signalled its intention to give system leaders greater agency and autonomy to identify the best way to deliver agreed priorities in their local context.

At the heart of ICSs, the ICBs and ICPs should embed shared leadership and collaboration across all the different sectors and partners involved and a new way of the system coming together to make decisions and hold each other to account.

Background to this call for evidence

To help inform this new way of working, the Secretary of State for Health and Social Care has appointed the Rt Hon Patricia Hewitt to consider how the oversight and governance of ICSs can best enable them to succeed.

More information about the objectives and scope of the review can be found in the Hewitt review terms of reference.

We are therefore launching this call for evidence to gather views from across the health and social care system, as well as from patients, the public, and the wider voluntary sector.

Questions

You can respond as an individual, or on behalf of an organisation by completing the online survey.

The deadline for responses to the call for evidence is 9 January 2023.

Empowering local leaders

As the system moves towards new ways of working, we are keen to explore how we can empower local leaders within ICSs.

Question

Please share examples from the health and care system, where local leaders and organisations have created transformational change to improve people’s lives. (250 word limit)

This can include the way services have been provided or how organisations work with residents and can be from a neighbourhood, place or system level.

Question

Do you have examples where policy frameworks, policies and support mechanisms have enabled local leaders and, in particular, ICSs to achieve their goals? (250 word limit)

This can include local, regional or national examples.

Question

Do you have examples where policy frameworks, policies, and support mechanisms that made it difficult for local leaders and, in particular, ICSs to achieve their goals? (250 word limit)

This can include local, regional or national examples.

Question

What do you think would be needed for ICSs and the organisations and partnerships within them to increase innovation and go further and faster in pursuing their goals? (250 word limit)

Question

What policy frameworks, regulations or support mechanisms do you think could best support the active involvement of partners in integrated care systems? (250 word limit)

Examples of partners include adult social care providers, children’s social care services and voluntary, community and social enterprise (VCSE) organisations. This can include local, regional or national suggestions.

National targets and accountability

Question

What recommendations would you give national bodies setting national targets or priorities in identifying which issues to include and which to leave to local or system level decision-making? (250 word limit)

Question

What mechanisms outside of national targets could be used to support performance improvement? (250 word limit)

Examples could include peer support, peer review, shared learning and the publication of data at a local level. Please provide any examples of existing successful or unsuccessful mechanisms.

Data and transparency

We recognise that key to reaching greater local control and accountability is the transparent use of data, both at a local and national level.

Question

Do you have any examples, at a neighbourhood, place or system level, of innovative uses of data or digital services? (250 word limit)

Please refer to examples that improve outcomes for populations and the quality, safety, transparency or experience of services for people; or that increase the productivity and efficiency of services.

Question

How could the collection of data from ICSs, including ICBs and partner organisations, such as trusts, be streamlined and what collections and standards should be set nationally? (250 word limit)

Question

What standards and support should be provided by national bodies to support effective data use and digital services? (250 word limit)

System oversight

ICSs are continuing to develop, and DHSC, NHS England and the Care Quality Commission (CQC) are still in the process of developing their working relationships with them.

We recognise that there is significant variation in maturity, capability and performance between different systems and partner organisations, including trusts. This will require an appropriate balance between autonomy, support, regulation and intervention. We are keen to explore whether there are any principles we can identify to help set that balance.

Question

What do think are the most important things for NHS England, the CQC and DHSC to monitor, to allow them to identify performance or capability issues and variation within an ICS that require support? (250 word limit)

Question

What type of support, regulation and intervention do you think would be most appropriate for ICSs or other organisations that are experiencing performance or capability issues? (250 word limit)

Additional evidence

Question

Is there any additional evidence you would like the review to consider? (250 word limit)

See the Hewitt review terms of reference as a guide to what additional evidence may be relevant.

Next steps

The evidence gathered from this exercise will inform the findings of the review.

If you have any questions about the review, contact [email protected].

Privacy notice

Summary of initiative or policy

The Hewitt review will consider how the oversight and governance of integrated care systems (ICSs) can best enable them to succeed, balancing greater autonomy with robust accountability with a particular focus on real time data shared digitally with DHSC, and on the availability and use of data across the health and care system for transparency and improvement. It will cover ICSs in England and the NHS targets and priorities for which ICBs are accountable, including those set out in the government’s mandate to NHS England.

In particular, it will consider and make recommendations on:

• 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 integrated care boards (ICBs) should both be held accountable and supported to improve by NHS England and other national bodies, alongside local priorities reflecting the particular needs of communities

• how the role of CQC can be enhanced in system oversight

Data controller

The data is controlled by the Department of Health and Social Care

What personal data we collect

We wish to collect respondents’ full names and email addresses. We will also ask for the name of their organisation, their job title as well as collecting information about the type of organisation that their work for and their membership of certain health and care bodies.

How we use your data (purposes)

We may use this data to contact individual respondents for further discussions, and in order to inform the deliberations of the review.

This is to ensure that the review is hearing from an appropriate range of respondents.

Legal basis for processing personal data

Under the Article 6 of the UK General Data Protection Regulation (GDPR), the lawful bases we rely on for processing this information are:

• (e) Necessary task in the public interest or controller’s official authority

Data Processors and other recipients of personal data

We will not pass this data to any third party outside the independent chair of the review, and the supporting Secretariat provided by the Department of Health and Social Care.

International data transfers and storage locations

Data will be stored by the Department of Health and Social Care.

Retention and disposal policy

We will retain this information for the length of the review, which is due to conclude in March 2023.

How we keep your data secure

We will store this material within the DHSC secure system and in line with DHSC’s data protection rules.

Your rights as a data subject

By law, data subjects have a number of rights and this processing does not take away or reduce these rights under the EU General Data Protection Regulation (2016/679) and the UK Data Protection Act 2018 applies.

These rights are:

1. The right to get copies of information – individuals have the right to ask for a copy of any information about them that is used.

2. The right to get information corrected – individuals have the right to ask for any information held about them that they think is inaccurate, to be corrected

3. The right to limit how the information is used – individuals have the right to ask for any of the information held about them to be restricted, for example, if they think inaccurate information is being used.

4. The right to object to the information being used – individuals can ask for any information held about them to not be used. However, this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case.

5. The right to get information deleted – this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case.

Comments or complaints

Anyone unhappy or wishing to complain about how personal data is used as part of this programme, should contact [email protected] in the first instance or write to:

Data Protection Officer
1st Floor North
39 Victoria Street
London
SW1H 0EU

Anyone who is still not satisfied can complain to the Information Commissioners Office. Their website address is www.ico.org.uk and their postal address is:

Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Automated decision making or profiling

No decision will be made about individuals solely based on automated decision making (where a decision is taken about them using an electronic system without human involvement) which has a significant impact on them.

Changes to this policy

This privacy notice is kept under regular review, and new versions will be available on our privacy notice page on our website. This privacy notice was last updated on 13 December 2022.