Intended for healthcare professionals


Patricia Hewitt’s review of the latest NHS reforms

BMJ 2023 ; 381 doi: (Published 14 April 2023) Cite this as: BMJ 2023;381:p837
  1. Hugh Alderwick , director of policy
  1. Health Foundation, London, UK
  1. Hugh.Alderwick{at}

A mixed bag of proposals on some very familiar themes

Last week, the UK government published the findings of an independent review into the latest NHS reforms in England, 1 led by Patricia Hewitt, Labour health secretary between 2005 and 2007 and now chair of one of the NHS’s new integrated care systems. The review was established in November 2022 to consider changes to the governance and oversight of integrated care systems—42 regional bodies responsible for planning services to improve health and reduce health inequalities—less than six months after they were created. 2

Hewitt’s report and recommendations are wide ranging—from how NHS organisations work together locally to the government’s broader approach to improving the nation’s health. The main themes are achingly familiar: a greater focus on preventing ill health and reducing health inequalities, stronger collaboration across the NHS and other services, more local control over decision making, and less reliance on top-down performance management to stimulate improvement. Hewitt’s proposals for how to make this happen are a mixed bag.

The review calls for a shift in NHS spending towards …

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