9th January 2023
iHV submits response to the Hewitt Review consultation on Integrated Care Systems
Just before Christmas, the Government launched their consultation on the oversight and governance of Integrated Care Systems (ICSs) in England. The Secretary of State for Health and Social Care appointed the Rt Hon Patricia Hewitt to lead this review with a 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 – the call for submissions closed today, 9 January.
ICSs were placed on a statutory footing on 1 July 2022, with 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, with the aim 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 iHV has submitted written evidence to this review which sets out the vital role that health visitors play in achieving these ambitions – as an infrastructure of support, and the ‘backbone of the early years… the safety-net around all families’ (WHO UNICEF UK, 2022).
Health visitors are highly skilled Specialist Community Public Health Nurses, ideally placed to act as local leaders in ICSs, working collaboratively with others to facilitate a place-based response to improve health and reduce inequalities. All families have a health visitor, and their frontline practitioner intelligence provides an important ‘early warning signal’ of the most pressing threats to the health of our youngest citizens who are often hidden behind front doors and invisible to other services.
However, our submission also highlights that ICSs are being developed in deeply challenging times for babies, children and their families, with increased levels of need and widening inequalities, alongside political and economic instability, and varied levels of healthcare performance. Health visiting faces a significant workforce shortage, with almost 40% fewer health visitors compared to 2015, and problems with recruitment, retention and career progression. Consequently, many families are not receiving the support that they need, and this is being intensified by a lack of capacity in other health and social care services who are also experiencing extreme pressures – with increased risk and detrimental impacts on child health and development.
We want ICSs to succeed. It is not too late to change direction and pursue reforms, but the situation is serious. The current rate of health visitor workforce attrition, with no national workforce plan to plug the forecasted gaps, is not sustainable and will jeopardise the delivery of England’s child health programme. The government categorised health visiting as one of six priority services in its Start for Life Vision for the first 1001 days. However, this commitment is at risk without investment and a plan to rebuild the health visitor workforce. There is also a significant risk that the current context makes it harder for the original vision of much better-integrated care across the system to be fulfilled.
More information about the objectives and scope of the review can be found in the Hewitt review terms of reference.
