Classification: Official
Publication reference: PR00557

To:

• Integrated care board (ICB):
  • Chief executives
  • Chairs
  • Integrated care partnership (ICP) chairs

cc.

• Regional directors

Dear colleagues,

Hewitt Review and Health and Social Care Select Committee report on integrated care system autonomy and accountability

The Government has today published its joint response to the Hewitt Review and the Health and Social Care Select Committee’s report on integrated care system (ICS) autonomy and accountability. I want to thank you, and all partners across the health and care sector, for dedicating your time, energy and views to these important reports.

Almost a year on from their establishment, support for ICSs as the right arrangements to address the shared challenges being faced across the health and care system remains strong. Up and down the country ICSs are embedding their local partnerships and working to improve the way that health and care is delivered and experienced in communities. Together, they are tackling the critical challenges we face including improving population health for local communities, urgent and emergency care transformation, recovery of elective services, access to primary care and building the resilience of the health and social care workforce.

The Hewitt Review emphasises the work already happening locally and nationally to capitalise on these new arrangements, acknowledging some of the significant progress that both systems and NHS England have started to make and highlighting where we need to do more to ensure our approach across the NHS and with partners enables local leaders to succeed.

Our Operating Framework sets out how we are starting to work differently, and we are changing to become a smaller organisation that is focussed on supporting leaders and their teams in local organisations and enabling them to deliver our collective core priorities.

We now want to work collaboratively with systems and national partners to drive that change forward through a clear roadmap for the future changes we will make together. This will pick up how we set direction for the NHS, how we assure delivery and support improvement, and how we align ways of working to build a collaborative culture that enables success – all oriented to align behind local leaders. 

As part of this we will consider how we can:

• embed co-creation and co-ownership into our ways of working as part of demonstrating our commitment to collaborative leadership by, for example, building on this year’s approach to co-produce the next round of planning guidance to ensure the way that we develop national priorities and set direction will be genuinely informed by local ambition.
• streamline how we interact with systems as we devolve decision-making to give systems the space to lead locally, seeking to minimise reporting requirements so that capacity and energy can be focused on developing tomorrow’s services rather than describing today’s services.
• develop the ‘one team’ approach we are embedding across the NHS and with our partners, working collaboratively and empowering each other but also being clear about who is accountable for what within systems. This will mean a shift in our oversight framework and our approach to performance management to place a stronger emphasis on improvement and transformation.
• better listen to local leaders in systems to inform how we reorganise our ways of working. Our behaviours and culture need to reinforce these ambitions as we seek to create a simpler and more enabling NHS England to lead the NHS more effectively.

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.

We look forward to working in collaboration with colleagues to take this important work forward.

Yours sincerely,

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