Greater powers for high-performing local health leaders and fewer national targets are foreseen under plans to change the NHS from a “illness” service to a “health” service.

A government-commissioned report, published on Tuesday, proposed a package of measures designed to ensure the health service focuses on preventing ill-health rather than simply treating it, including a more consistent approach to funding.

Patricia Hewitt, former Secretary of Occupational Health who led the report, described the National Health Service as “more of a national disease service than a national health service”. It was mandated to examine the role of “integrated care systems” in England’s NHS, statutory bodies that bring together health authorities, local government and the voluntary sector to plan and finance healthcare.

Hewitt suggested that the current funding strategy did not support a precautionary approach. “ICS partners struggle to work in overly complex and uncoordinated funding systems and rules to move resources to where they are needed most,” she said.

“Multi-year funding horizons were required, with proportionate reporting requirements,” it added.

Hewitt also recommended that the share of ICS-level NHS budgets spent on prevention be increased by at least 1 per cent over the next five years.

Not only money was required, but different ways of working, according to the report. The most effective ICS should work with NHS England “to develop a new model with a much greater degree of autonomy, combined with strong and effective accountability.”

In particular, around 10 of the more “mature” ICS should work with health and local government departments to create new “highly accountable and responsible partnerships”, which would operate from April next year.

The framework for Harps should include “a radical reduction in the number of shared national priorities and corresponding [key performance indicators]”. Instead, he proposed “a small number of priorities” for which the associations would be held accountable.

On the other hand, Hewitt urged ministers to “significantly reduce the number of national objectives, certainly with no more than 10 national priorities”.

Last month, NHS England announced that the Operating Cost Allocation (RCA) for Integrated Care Boards, part of the ICS, which had already been frozen in cash terms for the fiscal year 2023 to 2024, would be further reduced. by 30 percent in real terms. for the next two years.

Noting “the intense pressures on the nation’s finances, as well as the population,” Hewitt said, “the scale and timing of these reductions create a real threat to the successful development of ICS.”

He suggested that a planned 10 percent cut in the RCA for the 2025-26 fiscal year be reconsidered before next year’s budget.

The Department of Health and Social Care said: “ICS are an important part of the government’s plan to deliver more coordinated and effective health and care services and reduce waiting times for patients, one of the prime minister’s key priorities for 2023.

“Ministers will review the recommendations in this report in due course.”

Separately, the government has come under fire after an announcement on social care funding on Tuesday revealed that only around £250m had been earmarked to boost the social care workforce, compared with the at least £500m pledged a year ago.

Labour’s Liz Kendall, shadow social care minister, said: “This is a total betrayal of the elderly and disabled and a care system that has been stretched to the breaking point.”

Sally Warren, policy director at the King’s Fund, said: “When social care trends go in the wrong direction, it is short-sighted for government to backtrack on what was already minimal funding.”

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