Greater powers for high-performing local health leaders and fewer national targets are in prospect under plans to shift the NHS from an “illness” to a “health” service.
A government-commissioned report, published on Tuesday, proposed a package of measures designed to ensure that the health service focuses on preventing ill health rather than simply treating it, including a more consistent approach to funding.
Patricia Hewitt, former Labour health secretary who led the report, described the NHS as “more of a national illness service than a national health service”. She had a remit to examine the role of “integrated care systems” in England’s NHS, statutory bodies that bring together health authorities, local government and the voluntary sector to plan and fund healthcare.
Hewitt suggested the current funding strategy did not support a preventive approach. “ICS partners struggle to work around over-complex, uncoordinated funding systems and rules in order to shift resource to where it is most needed,” she said.
“Multiyear funding horizons, with proportionate reporting requirements,” were required, she added.
Hewitt also recommended that the share of NHS budgets at ICS level going towards prevention should be increased by at least 1 per cent during the next five years.
Not just money but different ways of working were required, the report said. The most effective ICSs should work with NHS England “to develop a new model with a far greater degree of autonomy, combined with robust and effective accountability”.
In particular, about 10 of the most “mature” ICSs should work with health and local government departments to create new “high accountability and responsibility partnerships”, which would operate from April next year.
The framework for Harps should include “a radical reduction in the number of shared national priorities and corresponding [key performance indicators]”. Instead, it proposed “a small number of priorities” for which the partnerships would be held accountable.
Separately, Hewitt urged ministers to “significantly reduce the number of national targets, with certainly no more than 10 national priorities”.
Last month, NHS England announced that the running cost allowance (RCA) for integrated care boards — part of ICSs — which had already been frozen in cash terms for the 2023 to 2024 financial year, would be further cut by 30 per cent in real terms over the following two years.
Noting “the intense pressures upon the nation’s, as well as the population’s, finances”, Hewitt said, “the scale and timing of these reductions create a real threat to the successful development of ICSs”.
She suggested a planned 10 per cent cut in the RCA for the 2025-26 financial year should be reconsidered before next year’s Budget.
The Department of Health and Social Care said: “ICSs are an important part of the government’s plan to deliver more joined-up and effective health and care services and to cut waiting times for patients, one of the prime minister’s key priorities for 2023.
“Ministers will review recommendations of this report in due course.”
Separately, the government has come under fire after an announcement on social care funding on Tuesday revealed that only about £250mn had been earmarked to boost the social care workforce, compared with at least £500mn promised a year ago.
Labour’s Liz Kendall, shadow social care minister, said: “This is a total betrayal of older and disabled people and a care system that has been pushed to breaking point.”
Sally Warren, director of policy at the King’s Fund, said: “When social care trends are going in the wrong direction, it is short-sighted for government to row back on what was already minimal funding.”
