Neither Healthy, Wealthy nor Wise

Long waiting times, low quality of care, both patient and doctor dissatisfaction, the NHS is not in a good place. The need for broad reform is clear. 

The government recognised this and last year the Chancellor engaged Patricia Hewitt (Labour Health Secretary 2005/7) to advise how the NHS should be reformed. Instead, only 2 weeks late - pretty good for the NHS - we got her report on integrated care systems (ICSs). As Deputy Chair of the Norfolk and Waveney Integrated Care Partnership Hewitt, is unsurprisingly keen on ICSs.

The thesis is that patient care would be enhanced if the NHS and social care providers worked more closely, optimising the individual's care with greater community involvement. No one will argue with that as an ideal but delivering it is another matter. And it will not cure the NHS.

“Integrated care systems (ICSs) are partnerships that bring together local government, the NHS, social care providers, voluntary, community, faith and social enterprise (VCSFE) organisations and other partners to improve the lives of people who live and work in their area.” (1.3)

In other words, ICSs are local multi-tier bureaucracies distracting front line medical and care staff from face time with patients and carers. Not exactly the panacea promised. 

The Hewitt Report should be read alongside the February 2023 Report from the Public Account Committee which documents some of the problems and concludes “In short, on ICSs, the jury is clearly still out”. Apart from their inherent added costs and time-wasting, ICS problems include: Who do they report to? Who pays for what? For an individual patient/caree, who decides what the system will do for him/her?  

Hewitt however is wonderfully utopian: 

“ICSs bring together all the main partners - local government, the voluntary, community, faith and social enterprise sector, social care providers and the NHS - in a common purpose expressed in 4 main aims: to improve outcomes in population health and healthcare; to tackle inequalities in outcomes, experience and access; to enhance productivity and value for money; and to help the NHS support broader social and economic development.” 

Some of us believe the NHS is there to treat and cure people, not supplant the government.  The Department of Health and Social Care (DHSC) and local authorities have huge departments dealing with broader health matters, like telling us to take more exercise, so why should the NHS, and DHSC, come to dabble in that area too?

Unfortunately, Patricia Hewitt also doesn't practise what she preaches. According to a local doctor, a North Norfolk surgery that comes under the wing of her ICS will be closed with no consultation even though the local council has been opposing it for months.  They have been ignored and the local community will now be faced by long drives (if they have cars). To tick the boxes, a “consultation” may take place but the decision has already been made. 

There is a mantra, popular among politicians, that prevention is cheaper and more effective than treatment and cure. If we had better prevention, apparently, none of us would get sick at all so we’d hardly need an NHS. Yes, I know immunisation works, but it has limited application. As for the idea, prevalent in Hewitt’s Report (1.12 – 1.15) that ICSs can remove health inequalities – tell that to the Chancellor. Health inequalities are driven by wealth inequalities.

The NHS should be removed from government and become a public corporation run by its CEO, Amanda Pritchard. It should focus on what it is betterat: treatment and cure. Social care today has no national CEO in parallel with the NHS, but it should have and it should also become a public corporation.

Of course they should cooperate at the local level, just as an army unit works closely with its neighbours, but they should not indulge in endless committee meetings taking doctors away from patients. Each GP should have an opposite number in social care with whom to liaise over mutual patients/carees. There is no need to involve the rest of the local ICS. Prevention (health) management should be examined closely to distinguish what works (free school meals for example) from what does not. 

Indeed, we have no real need of ICSs at all.