• New independent review of Integrated Care Systems to improve health outcomes across the country

• Former Health Secretary the Rt Hon Patricia Hewitt, Chair of NHS Norfolk & Waveney Integrated Care Board has been appointed as Chair

The government has announced a new independent review into oversight of Integrated Care Systems (ICSs) to reduce disparities and improve health outcomes across the country, following record investment in health and social care.

The review will be led by former Health Secretary the Rt Hon Patricia Hewitt who is currently Chair of NHS Norfolk & Waveney Integrated Care Board, and will explore how to empower local leaders to focus on improving outcomes for their populations.

This includes giving them greater control and making them more accountable for performance and spending, reducing the number of national targets, enhancing patient choice and making the healthcare system more transparent.

The Health and Care Act established 42 Integrated Care Systems across England in law on 1 July. The new systems are a crucial part of the government’s vision to bring together the NHS and local government to jointly deliver for local communities and boost access to care.

Yesterday’s Autumn Statement also announced up to £8 billion more for the NHS and adult social care in England in 2024-25 on top of record funding, ensuring the NHS can address the most pressing issues facing the health service this winter. This includes continuing to provide care to the most vulnerable, reducing the backlog of those waiting for elective surgeries and improving access to emergency and primary care.

Health and Social Care Secretary Steve Barclay said:

I’m focused on supporting the health and care system through what we know will be a challenging winter but also crucially making the changes that will better prepare us for the future.

Rather than a one-size-fits-all approach dictated from a ministerial office, local leaders are best placed to make decisions about their local populations and I want to empower them to find innovative solutions to tackle problems and improve care for patients.

Fewer top-down national targets and greater transparency will help us deliver this aim and I am grateful to Patricia Hewitt for agreeing to lead this vital review to help us get this right. I look forward to reviewing her findings.

Rt Hon Patricia Hewitt, Chair of NHS Norfolk & Waveney Integrated Care Board said:

I am delighted to have been asked to lead this review of how Integrated Care Systems can best be empowered and supported to succeed.

By bringing together local government, the NHS and the voluntary, community and social enterprise sector, ICSs provide the biggest opportunity in a generation to improve health outcomes, transform health and care services and reduce health inequalities. Despite the many challenges we face, I am excited by how much has already been achieved in many different systems, including in Norfolk and Waveney, and optimistic about what our partnerships can do in future as we respond to the different needs of our own communities.

This review will focus on how national policy and regulation can most effectively support and enable local systems to solve problems locally. It will build on the welcome work already done by NHS England to develop a new operating model.

I look forward to working with colleagues from all 42 ICSs as well as DHSC, NHSE, colleagues in local government and others as we respond to the Health Secretary’s and the Chancellor’s invitation to help create a system of regulation and accountability based on the principle that change should be locally led and nationally enabled.

Richard Meddings, Chair of NHS England:

As a health service we are focused on delivering the best possible care for all our patients, as well as value for taxpayers.

With both the economy and the NHS facing tough challenges ahead, it’s absolutely right that we continue to find more innovative ways to ensure all our systems are working as efficiently as possible. We also need to continue to provide the tools to help local systems solve the problems they face on the ground – building on the operating model we have already set out.

That’s why we welcome this week’s announcement of a new independent review and will work closely with its chair, the Rt Hon Patricia Hewitt, to help the NHS to continue to deliver for patients, as well as the public purse.

The review will consider:

• The scope for a smaller number of national targets to empower local health and care leaders and enable greater autonomy, so they have the time and resource to focus on innovating and tackling local challenges and priorities.

• How local performance could be better monitored and any local targets set, with a focus on transparency.

• How to ensure new ICSs are held robustly to account, both locally and nationally.

• The relationship between ICSs, and central bodies, such as NHS England and the Care Quality Commission (CQC), as well as the CQC’s role in oversight of ICSs.

An interim report is expected before the end of the year, with a final report in the new year, which will inform the NHS’s objectives and planning.

The review will draw upon the expertise of ICS leaders, NHS England and other experts including in academia, government and relevant thinktanks, as well as local government, voluntary sector and patient representatives.

Background

• Each ICS has an Integrated Care Board (ICB), a statutory organisation bringing the NHS together locally to improve population health and establish shared strategic priorities within the NHS. They include representatives from local authorities, primary care and NHS trusts and are accountable for the performance of the NHS across their area.
• Each ICS also has an Integrated Care Partnership (ICP), bringing together a wider group of partners to set the strategy for the system as a whole, focusing on the four goals of ICSs: improve outcomes in population health and healthcare; tackle inequalities in outcomes, experience and access; enhance productivity and value for money; and help the NHS support broader social and economic development.
• The terms of reference will be published in due course.

Thank you for that kind introduction. It is a great pleasure to be here with you and able to speak about examinations in my role as chair of Ofqual.

I am going start by saying something about examinations in 2023 and then end by reflecting briefly on the future of examinations, especially in the light of increasing digitisation.

Exams and other formal assessments that are like exams give students the fairest chance to show what they know, understand and can do, because the rules are the same for everyone.

And at Ofqual it’s students’ interests that drive our decisions; both this year’s students, and past and future students. For us, that means qualifications that maintain their value, now and in the future, and stand the test of time.

We’ve done a lot of canvassing of opinion from students in schools and colleges, their parents and their teachers. And all of those groups tell us the same message: overwhelming positivity about the return to normal examinations after the difficult arrangements of the COVID-19 years.

This is certainly my own experience from the young people I talk to as a trust leader and around the country.

Examinations in 2023

This summer was an important step back towards normality. Our plans for 2023 take us a step further, whilst also recognising the impact of the COVID-19 pandemic.

We have already announced that, in 2023, as well as running examinations pretty much as normal we will also return to pre-pandemic grading.

In so doing, however, we’re going to provide the 2023 cohort with the same protections against any impact of COVID-19 disruption that we did for earlier cohorts during the reform years. This feels like the right thing to do.

Students in the 2023 cohort have not, during their examination courses, experienced national school or college closures, but we do know they have experienced some disruption, and certainly earlier on in their schooling disruption was evident.

So to achieve that extra bit of protection we are putting in place the same safeguards that were used for the first cohorts of students taking reformed GCSEs and A levels from 2017 onwards.

That meant not disadvantaging students who might have performed less well because they were the first to sit new exams.

So let’s just have a slightly closer look at what this means in practice.

As in any year, grade boundaries for every specification will be set by senior examiners after they have reviewed the work produced by students in their exams.

But those senior examiners will be guided in their decisions about where to set grade boundaries by information about the grades achieved in pre-pandemic years, along with prior attainment data.

That means the 2023 cohort will be protected in grading terms if their exam performance is a little lower than it might have been before the pandemic.

Broadly speaking, therefore, a typical student who would have achieved an A grade in their A level geography before the pandemic will be just as likely to get an A next summer, even if their performance in the assessments is a little weaker in 2023 than it would have been before the pandemic.

We do expect therefore that overall results in 2023 will be much closer to the pre-pandemic years than results since 2020.

In other words, overall national results in 2023 will be lower than in 2022. Individual schools and colleges should be prepared for this.

We always said that this year, 2022, was a ‘one off’ transition year. If you are in a school or college, it is very misleading to compare your results in 2022 with any other year.

And looking ahead to next year, lower results in 2023 compared with 2022 will not mean, by itself, that your school’s or college’s performance has fallen. It will be much more likely to be a reflection of the return nationally to normal grading standards.

I know as a school leader that it can feel worrying when results come in lower than the previous year. But to repeat: we should not compare 2023 results with 2022, and certainly not with 2020 or 2021 when we had no exams at all.

Now obviously at this point in the academic year, we can’t be precise about results in specific subjects and specifications. Entries have not yet been made and students have not taken any exams.

But it is important to note that, as I have said, while broadly speaking we aim to return to normal grading in 2023, there is no pre-determined ‘quota’ of grades.

There will always be variations because marks and grades are determined by candidates’ performance and expert examiner judgement of that performance as they decide where exactly grade boundaries should be for each examination.

Alongside this approach to grading, i.e. a broad return to normal with some safeguards to protect students, we have also consulted on a couple of specific changes to continue to give students a bit more support in the experience of taking exams in 2023.

The first one I want to mention this morning concerns MFL – modern foreign languages – GCSEs where we propose not requiring exams to contain vocabulary from outside the vocabulary list, and allowing exam boards to supply meanings for any words that they do use from outside that list. And that will in any case be in line with changes to GCSEs in French, German and Spanish coming down the line.

And the second specific I wanted to flag this morning is the consultation that we have recently done on students being given formulae sheets for maths and equation sheets for science, which we did this year for science GCSEs. If we implement that proposal, like the MFL changes, it would also give some additional reassurance to GCSE candidates in the examination itself.

We will publish the outcome of these consultations and final decisions very soon.

Just a word on vocational and technical qualifications (VTQs) taken in schools and colleges, alongside or instead of GCSEs and A levels. For these, awarding organisations are expected to take account of the approach being used in GCSEs and A levels so that students taking VTQs are not advantaged or disadvantaged in comparison. So for the VTQ suite of qualifications, this also means in 2023 a return to normal standards.

Teachers this term are predicting grades for their students to use in their UCAS applications. Indeed, many students will already have been given an indication of their predicted grades by their teachers.

It can – and I know this as a teacher – be challenging for teachers to predict grades accurately at the best of times. In summer 2022, predicted grades overall, at national level, were at their highest level ever.

We expect predicted grades for summer 2023 to be much closer to those seen in the pre-pandemic years. For 2023, we have recommended that teachers use the familiar pre-pandemic standard as the basis for predicting their students’ grades.

But there is one note of caution: if you are using summer 2022 papers as mock or trial exams, either this autumn or in the spring, be aware that the grade boundaries you have for those were set with the higher 2022 transition grading standard in mind. You will need to factor that in when giving indicative grades for candidates being examined from 2023 onwards.

Just another word about universities and higher education: decisions about grading have no effect on the quantum of higher education places available. That is not affected by grading decisions.

Universities themselves will take account of how exams will be graded when they make their offers, including any differences between the 4 nations of the UK (which already exist). They are already well experienced in making those adjustments.

The future of examinations

I want to turn now to the future of examinations, in particular in the light of the digital revolution which is playing out in so many aspects of our lives.

It is worth saying up front that it is not Ofqual’s job to be an evangelist for technology as an end in itself. Our job is to regulate the exams and qualifications market to make sure it works fairly in the interests of young people, and that qualifications have value and can be trusted.

However, greater use of technology in GCSEs, A levels and other high-stakes exams is coming down the track and it’s probably a case of when, not if. We know it’s happening in other aspects of life and it’s happening in other countries.

But we must be led by the evidence and do only what is right for students. We cannot take risks with young people’s qualifications and we must have regard to robust evidence, always thinking, as a priority, about the situation of the most disadvantaged students to ensure they have a fair crack of the whip.

That’s why we have committed to undertake considered and thorough work to look at the opportunities, challenges, risks and benefits of technology in assessment.

So if exam boards tell us they want to use technology for some aspect of their examinations, we need, as a regulator, already to have done the spade work to know what we should expect from exam boards to make sure they use technology well, and fairly, and in the interests of all students. There is a lot for us to understand to make sure we can make those decisions well.

Awarding organisations and government will be thinking about things like how to develop onscreen assessment platforms, and the practical but all-important requirement of ensuring reliable broadband connections are available for every school, because they will need that if they are going to do live, onscreen assessment.

But as a regulator our approach will be cautious. What we will be doing at every turn is considering the evidence, and considering in particular students’ interests, and keeping that at the forefront of our decision-making.

I have to say that I do not personally envisage a world where students sit exams solely onscreen. Handwriting is still an essential part of our education and is probably best assessed with pen and paper.

The benefits of possible future onscreen assessment are likely to vary by subject. In maths, it may be that it is easier to use pen and paper to show workings. Computer programming, however, is both an essential skill for the future economy and probably one we can all agree is better assessed on a computer.

There will be others too where onscreen assessment enables more valid, realistic and accurate assessment. But we just need to understand all of that properly and make cautious and wise decisions for the system as a whole, keeping students’ interests at the forefront of our minds.

There are further benefits to onscreen assessments. For example, onscreen assessments may make exams more accessible for some candidates with special education needs and disabilities (SEND). It might also make it easier to make adjustments for pupils who are entitled to them digitally rather than on paper.

The move to digital assessment, however, can only come about through joint endeavour. It will take schools, teachers, parents, exam boards, the Department for Education, Ofqual and others to work together. We will need to make a detailed and sober assessment of risks and benefits, and not experiment with young people’s futures.

And as the successful return of exams this summer has shown, doing that sort of joint endeavour is well within our grasp.

Yesterday (Thursday 17 November), the Chancellor delivered his Autumn Statement to the House of Commons, announcing a raft of measures aimed at ensuring the UK’s economic stability, continuing growth, and providing support to the most vulnerable.

The Chancellor highlighted how the government’s priority is to tackle inflation and prevent it eating into the paycheques and savings of people across the country, while eliminating disruption to business growth plans.

Among the key measures that BEIS will be charged with delivering is an uplift in the National Minimum Wage and the largest ever cash increase in the National Living Wage – helping protect over 2.5 million of the lowest-paid workers in the UK against the rising cost of living.

As well as continuing to support households with their energy bills by extending the Energy Price Guarantee, the Autumn Statement also prioritised boosting the UK’s energy independence and efficiency. This includes an investment in Sizewell C and the creation of a new taskforce for energy efficiency.

The Chancellor also outlined how innovation would be crucial to unlocking economic growth, announcing that the government will be protecting £20 billion in research and development investment in 2024 to 2025.

Business Secretary Grant Shapps said:

We are doing everything we can to support the most vulnerable in these challenging times, and this Autumn Statement builds on the measures already in place to protect businesses and consumers over the coming months.

From delivering the biggest increase yet to the National Living Wage, to supporting businesses and households from rising costs and investing in innovative new technologies, we are prioritising stability and growth to ensure the UK can prosper.

Among the BEIS policies announced in the Autumn Statement include:

Energy support

Energy Price Guarantee

The Energy Price Guarantee is a scheme which limits the unit price households pay for electricity and gas across the UK. It brings a typical household energy bill in Great Britain down to the equivalent of around £2,500 per year (for the period of 6 months) from 1 October 2022 to end of March 2023 (with equivalent support in Northern Ireland (NI)); and then to around £3,000 per year for a typical household in Great Britain from April 2023 to April 2024 (again with equivalent support in NI).

The government will consult on amending the scheme as soon as is feasible after April 2023 so that those who use very large volumes of energy have their state support capped, whilst the vast majority of households can continue to benefit. This proposal is intended to ensure taxpayers do not subsidise all of the energy usage of those households with extremely high usage. This consultation will explore the best ways to ensure that vulnerable high energy users, such as those with medical requirements, are not put at risk.

New approach from April 2024

The government will develop a new approach to consumer protection in relation to energy, which will apply from April 2024 onwards. It will work with consumer groups and industry to consider the best approach, including options such as social tariffs, as part of wider retail market reforms. The objectives of this new approach will be to deliver a fair deal for consumers, ensure the energy market is resilient and investable over the long-term, and support an efficient and flexible energy system.

Alternative fuel payments

The government will double the level of support for households that use alternative fuels, such as heating oil, liquefied petroleum gas (LPG), coal, or biomass, to heat their homes to £200. This support will be delivered as soon as possible this winter. The government will provide this payment to all Northern Ireland households in recognition of the prevalence of alternative fuel usage in Northern Ireland. The government will also provide a fixed payment of £150 to all UK non-domestic consumers who are off the gas grid and use alternative fuels, with additional ‘top-up’ payments for large users of heating oil based on actual usage.

Energy Efficiency Taskforce

The government will form a new Energy Efficiency Taskforce, charged with driving improvements in energy efficiency to bring down bills for households, businesses, and the public sector. The taskforce will support a new ambition to reduce energy demand from buildings and industry by 15% by 2030. New government funding worth £6 billion will be made available from 2025 to 2028, in addition to the £6.6 billion provided in this Parliament.

Energy security

Electricity Generator Levy

To help offset the costs of energy bill support schemes as well as vital public services, the government will be introducing a new temporary tax of 45% on certain electricity generators in the UK, called the Electricity Generator Levy. The levy, replacing the Cost Plus Revenue Limit, will be used to raise revenue from generators receiving extraordinary returns from higher electricity prices and will help fund the unprecedented package of support for energy bills the government is offering.

From January, the Energy Profits Levy on oil and gas companies will also increase from 25% to 35%, bringing the headline tax rate for the sector to 75% helping raise revenue, recognising their continued high profits. The Energy Profits Levy is applied to total profits rather than a measure of extraordinary returns and will come on top of other additional taxes applied to oil and gas production in the UK.

Sizewell C

Plans for the new plant at Sizewell C continue. Subject to final approvals, contracts are expected to be signed with relevant parties, including EDF, in the coming weeks. The project will create 10,000 highly skilled jobs for the area and provide reliable, low-carbon, power to the equivalent of 6 million homes for over 50 years. The government’s £700 million investment is the first state backing for a nuclear project in over 30 years and represents the biggest step in the UK’s journey to energy independence.

Backing business and workers

National Living and Minimum Wage increases

Over 2 million of the lowest-paid workers in the UK will receive a pay rise, as the National Living Wage rate is increased by around 10%, its largest ever cash increase. These generous increases will support workers across the UK with the rising cost of living and provide added certainty for businesses for the year ahead. The National Minimum Wage, which is designed for younger workers, also receives a generous rise that protects their employment prospects. The new rates, recommended by the Low Pay Commission, an independent body with worker and business representatives, will come into force in April 2023.

Digital Markets Competition & Consumers Bill

The Digital Markets Competition & Consumers Bill will be brought forward in the third Parliamentary session to reform the UK’s digital markets, competition and consumer laws, strengthening public and business confidence in the power of free markets, and provide new powers to the Digital Markets Unit. In doing this, consumers’ hard-earned cash will be further protected from scams and rip-offs, markets will become more competitive and dynamic, meaning consumers get the very best deals, and a new regime will be introduced to address the far-reaching market power a small number of very powerful tech firms have on the market.

Unleashing innovation

Research and development

Investing in R&D is absolutely vital to help the economy and businesses grow. The government will ensure £20 billion in research and development investment is protected in 2024 to 2025, to help unlock growth across the UK. R&D tax reliefs will also be reformed, to ensure that taxpayers’ money is spent as effectively and efficiently as possible.

Made Smarter

The government will extend the Made Smarter Adoption programme to the East Midlands, supporting more small and medium manufacturing firms in boosting their productivity, efficiency, and resilience through adopting advanced industrial digital technologies, including robotics and automation, additive manufacturing, and AI. The extension follows the positive feedback the Made Smarter Adoption programme has already received in the North East, West Midlands, North West, and Yorkshire and the Humber.

Catapult Network

Funding for the Catapult Network, which promotes research and development through business-led collaboration, will increase by 30% compared to the last 5-year funding cycle. This £1.6 billion investment will provide SMEs access to world-leading facilities, expertise, skills, and equipment; accelerating innovation clusters and stimulating additional private sector investment in R&D across the UK.

Background information

In full, the National Living and Minimum Wage increases are:

• National Living Wage (23+) to increase 9.7%, from £9.50 to £10.42
• National Minimum Wage (21-22) to increase 10.9%, from £9.18 to £10.18
• National Minimum Wage (18-20) to increase 9.7% from £6.83 to £7.49
• National Minimum Wage (under 18) to increase 9.7% from £4.81 to £5.28
• Apprenticeship National Minimum Wage to increase 9.7% from £4.81 to £5.28
• Accommodation offset to increase 4.6% from £8.70 to £9.10. The accommodation offset is the maximum amount of value for provision of a workers’ accommodation that can count towards National Minimum Wage pay

The Low Pay Commission, an independent body with worker and business representatives recommends the rates to the government every year. The government has accepted the Low Pay Commission’s rate recommendations in full.