Official review expected to recommend more powers for top local health leaders

A drive to improve the effectiveness of the NHS in England by devolving more power to successful local health leaders and reducing red tape is expected to underpin a forthcoming review into the running of the health service.

The state of the NHS will be a pivotal issue at next year’s general election with Prime Minister Rishi Sunak aware he must show improvements if he is to reassure voters the service is safe in Conservative hands.

More than 7mn people are currently waiting for hospital treatment and the authoritative British Social Attitudes survey this week showed just 29 per cent of Britons were satisfied with its performance, the lowest rating in its 40-year history.

In last year’s Autumn Statement, Patricia Hewitt, health secretary under Tony Blair, was commissioned to consider how integrated care systems (ICSs) can operate “efficiently with appropriate autonomy and accountability”.

ICSs are statutory bodies which include not only the NHS but also local government and the voluntary sector. They were formally established last year and are responsible for planning and funding most NHS services in their areas.

Hewitt’s appointment, which raised eyebrows among some Tory MPs because of her New Labour antecedents, is part of a drive to ask “challenging questions” about how to reform the health service.

Patricia Hewitt, a former health secretary, favours a system of ‘earned autonomy’ in the NHS © Hindustan Times/Getty Images

People with knowledge of Hewitt’s thinking — but who had not seen her final report due to be published on Tuesday — suggested she favoured a system of “earned autonomy” in which the strongest performing ICSs might be given more freedom and independence about how they operated.

These groups would still be bound by tight national performance targets in areas such as cancer treatment times, the people added.

In an interview with the Health Service Journal in December, Hewitt criticised the “very prescriptive detailed top-down management” experienced by health leaders in recent years, and said there should be more local autonomy.

However, she made clear that some ICSs would continue to need tighter oversight and her report is thought to have rejected any assumption that all ICSs would automatically gain the same level of autonomy.

She told the HSJ that ICSs were “at very different stages of maturity”, while some might have deep financial problems. “If I was sitting in NHS England or indeed as health secretary, I wouldn’t be handing over any cheque book to them without an awful lot of control.”

She is also thought to be keen to reduce the amount of detailed information that ICSs are required to submit to NHS England, reflecting the wide range of performance metrics.

The report aims to examine the “scope for a smaller number of national targets” to allow local health and care leaders “the time and resource to focus on innovation” and tackling challenges.

In a speech to the Policy Exchange think-tank last September, Steve Barclay, secretary of state for health and social care, said: “We need to act on the large number of priorities being set by the centre, many of which are not measured in a way that supports individual accountability.”

The Department of Health and Social Care said: “Integrated care systems (ICSs) are a crucial part of the government’s vision to bring together the NHS and local government to improve health outcomes for people in their communities and tackle inequalities in access to care.

“We are looking ahead to the findings of the independent review and will respond in due course.” 

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