The Integrator: Not the Hewitt review

Patricia Hewitt’s review of integrated care systems, accountability, and efficiency was passed to government on Wednesday. While it receives the finishing touches, we’ve dreamed up a few alternative recommendations:

Acronyms: All integration’s favourite three-letter initialisms must be extended to four letters, to prove that ICBs, ICSs, ICPs, PBPs, PCNs, and so on, are now full and equal partners with NHSE. Additional initials will be set nationally, but systems are free to determine locally what they will stand for.

Planning guidance: An ambitious but realistic trajectory will be set for annual reduction in the planning guidance page count. When it falls below zero, production will revert back from NHSE to the Department of Health and Social Care and it can start again at 100 pages.

Management costs: The NHS needs more managers, which is why ICBs must reduce managers by 30 per cent. But to ensure resilience, place-based provider collaboratives, acute provider collaboratives, mental health and learning disability collaboratives, and the provider collaboratives for other things, must all increase staffing costs by 50 per cent.

“Places”: 2022-23 has been a successful “shadow” year with “places” thriving, despite there sadly being not enough time for delegation of actual budgets or decision making. We will therefore extend this “shadow” “place” phase for the foreseeable.

CQC inspections: After swearing an allegiance to integration, the Care Quality Commission will rate ICSs as soon as possible. Each will receive a rating of “extremely outstanding”, “really very outstanding”, “very outstanding” or “outstanding”. But “special measures” will be called “special measures” again, rather than whatever it is meant to be called at the moment.

Performance management: It’s clear NHSE has the statutory responsibility for this, not ICSs, despite anything we might have said from about 2016 to 2021.

Reform: Failing ICSs rated only “outstanding” must merge with more outstanding neighbours by April 2024, as must any others identified by the NHSE chief operating officer.

Digital and technology: must be made a lot less complicated and difficult, especially AI.

Collaboration: Foundation trusts should remember their manners at all times, unless they achieve 110 per cent of 2019 elective activity, in which case they are allowed to behave however they like again for a defined quantum of time (see formula in technical guidance).

Primary care: GPs are at the heart of the vision for integrated local services, and better jolly well sort themselves out or we’ll send Wes Streeting round.

Local government: Councils are an essential partner whose unique democratic role serving the public is central to ICSs, and they should fix delayed discharges by next winter.

Tribute: A ceremonial photograph of Jeremy Hunt must be displayed in all ICB receptions and relevant virtual MS Teams backgrounds. A smaller image of the current health and social care secretary [whodat? - ed] may optionally be placed alongside.