Hewitt Review urges NHS to set fewer central targets

A review by a former shadow health secretary, Patricia Hewitt, has called for the government and NHS England to set fewer central targets, allowing for greater autonomy over how resources should be used based on the needs of local populations.

The review comes following a report by the Health and Social Care Select Committee, which proposed that Integrated Care Systems (ICSs) need greater autonomy to enable them to better prevent ill health and improve NHS productivity and care. The Hewitt Review considers how these recommendations can be put into practice.

It also recommends a shift in focus towards prevention and health promotion, a greater focus on long-term challenges (not just immediate short-term challenges) and unlocking the potential of primary and social care and their workforce.

Ms Hewitt summarises these objectives into six key principles, that will enable the government to “create the context in which ICSs can thrive and deliver”. These are:

1. collaboration within and between systems and national bodies;
2. a limited number of shared priorities;
3. allowing local leaders the space and time to lead;
4. the right support;
5. balancing freedom with accountability; and
6. enabling access to timely, transparent and high-quality data.

A greater focus on the future of general practice

The BMA has welcomed most of these principles – including reducing targets, giving greater autonomy to GPs and their teams, and an increased focus on prevention – but says there needs to be a greater focus on the future of general practice.

Dr Kieran Sharrock, BMA England GP committee acting chair, said: “We know practices are struggling to meet patients’ needs and the emphasis now must be on supporting practices, rather than penalising them. There is worryingly little detail within the Hewitt Review about how success is defined and by whom.

“A central fund to buy out ‘failing’ partnerships may be seen as appealing for those left with no other way out, but it’s not clear who decides when a practice is failing, and what powers they might have. Rather than improving community-based, holistic care, we’d worry that this would open the door to private companies strong-arming smaller practices into selling – destroying the continuity of care that they have built over many years.”

Dr Sharrock is now calling on the government to put GPs at the centre of discussions around the future of general practice, rather than just ‘consulting’ them. This includes overhauling the current GP contract so that it addresses increasing demand, plummeting workforce numbers and rising costs.

Measures must be backed by adequate funding

RCN Director for England, Patricia Marquis says the measures set out in the report are “starting points” which have the potential to “reverse the dramatic deterioration that health services are facing.”

She is now urging the government to publish the long-awaited workforce plan, and provide extra funding for the recruitment and retention of NHS staff.

“Ultimately this report highlights the importance of investing in the workforce – including training for staff and a strategy for the social care workforce. But nothing will be achieved without funding and investment from government.

“The bottom line is clear and has been highlighted again and again – invest in the workforce. Yet we are still waiting to see the long-promised workforce plan to recruit and retain the nursing staff needed for safe patient care. Without it, our NHS will remain in crisis while patients suffer,” she added.