FSRH and RCOG consultation response: Hewitt Review into oversight and governance of Integrated Care Systems

FSRH and RCOG have responded to a consultation led by Rt Hon Patricia Hewitt focused on how the oversight and governance of integrated care systems (ICSs) can allow them to succeed in their aims, balancing greater autonomy and robust accountability. Ms Hewitt served as Secretary of State for Health from 2005 to 2007. 

In our response, we focus on the need for the health system to enable women to have improved access holistic sexual and reproductive healthcare (SRH). This means integrating care around the needs of the individual, not institutional silos – with people able to get integrated advice and support across the breadth of SRH and women’s healthcare more widely. 
 
The review, which is independent of Government, will report to the Secretary of State for Health and Social Care, with a first draft by 31 January 2023 and a final report by 15 March 2023. 
 
Key points in FSRH’s response: 

• The split in responsibility for women’s reproductive health commissioning between multiple different bodies means that there is not a single body vested in ensuring the holistic needs of women are being met. This has meant that, due to pressures on public health budgets, investment in cost-effective interventions such as contraception is less incentivised. 
• The establishment of Integrated Care Systems provides a key opportunity for greater integration and collaboration within the healthcare system. We call on the Government to work effectively across system level (ICS) and national level (NHSE) to integrate the women’s health services commissioned by CCGs / ICSs with those commissioned by NHSE and local authorities – addressing gaps in the reproductive care pathway.Models of integrating care around the needs of women support ICSs in achieving their goals to improve outcomes in population health and health care and tackle inequalities in outcomes, experience and access. 
• The active involvement of partners across ICSs will be key in their success. It is important that different communities are represented to ensure the views and experiences of different women are reflected in planning, for example groups supporting women who have experienced religious-based violence or FGM. 
• Issues related to the fractured way in which reproductive healthcare is delivered have been compounded by a lack of overall ownership and accountability in women’s reproductive healthcare – leading to postcode variation in service provision.  
• While some progress has been made in addressing this lack of accountability, namely the appointment of a Government’s Women’s Health Ambassador for England, there are still outstanding commitments in the Strategy which would act as helpful mechanisms to support national leadership in this area. For instance, we are calling for a women’s health lead – with accountability for reproductive health – to be appointed in every ICS Board to ensure that holistic women’s reproductive health is prioritised in ICS planning. 

You can read our response in full here. 

More information on the Consultation is available here.