Key considerations from the Hewitt Review on ICSs

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The recently published Hewitt Review into the oversight, governance and accountability of integrated care systems (ICS) makes a number of recommendations to increase autonomy.

Welcomed by system leaders for its alignment in ethos with why many chose to enter into an ICS role, the review’s extensive findings call for greater freedom, control and flexibility:

“We have called for a shift from a top-down, centralised system of managing the NHS to a bottom-up system responsive and responsible to local communities.”

Here, in this short read, we unpack the key takeaways.

A reduction in national targets

The review calls for fewer central targets and an overall shift from a performance management culture towards fostering ‘self-improving’ systems. Local priorities should be given equal importance and systems a say in the future formulation of national directives, with no more than ten national priorities.

Focus on prevention

A central theme of the publication is a move from ‘focusing on illness to promoting health’. An approach centred on upstream intervention is to also be underpinned by changes in resource allocation. This includes an increase in the share of total NHS budgets at ICS level going towards prevention by at least one per cent over the next five years.

Funding and payments

Proposals recommend an end to short-term, non-recurrent funding pots and the adoption of ‘multi-year funding horizons’. In regards to the former, these are said to have a negative impact on the ability to plan and recruit and weaken accountability. Additionally, the review recommends greater financial flexibility with regards to intra system funding both in determining allocations and payment mechanisms.

The role of CQC

CQC should have an ‘enhanced role’ in the assessment of ICSs with a focus on development and improvement. Assessments should look at the level of collaboration within a given system and mutual accountability between system partners in particular.


Giving ICSs access to timely, relevant, high-quality and transparent data is outlined as one of the review’s six core principles. The publication outlines the need to incentivise the flow and quality of data between providers and systems. Best practice use cases are also highlighted with ICSs, most notably for management of at-risk patients groups.

Accountability and relationships

ICBs are uniquely placed to understand the ‘connectivity and interdependence’ between local providers and have a critical role in coordinating collaboration within their respective place-based partnerships. Thus, NHS England should ‘work with and through’ ICBs by default. Additionally, to help ICBs assume greater autonomy and accountability in systems in going forward, it is recommended the NHS England also work with ICB leaders to design a pathway towards maturity.


The review recognises the role digital and data technologies can play in supporting prevention and population health management. In particular, the publication highlights the need to enable ICSs to connect data from multiple sources and how integrated data is already supporting some high performing ICSs.

In addition, it is proposed that a minimum data sharing standards framework be developed and access to the shared care record be given to social care and VCFSE providers, community and mental health services and local authorities. The NHS App should also ‘become an even stronger platform for innovation’ and its code made open source to approved developers.

The Livi take

The review’s central focus on prevention and its advocacy for greater autonomy of ICSs are all positive steps that have been welcomed.

While leaders wait to see how proposals will be implemented, these recommendations lay solid foundations and could create more opportunities to do things differently within the scope of systems. While examples of high-performing ICSs show the essential role digital technologies can play in improving population health.

For more information

Read the full Hewitt Review here.

As the UK’s leader digital healthcare provider, Livi is working with ICS, ICBs and primary care partners. To find out more about how our Livi Population service can support your organisation, contact our team on or click here to schedule a meeting.