DHSC supports the intent behind the recommendation and will undertake further work as ICSs mature to understand how it could be implemented in practice. The provisions in the Health and Care Act 2022 are enabling, permissive and flexible, allowing the NHS and wider health and care system to respond to the needs of their populations. We want to empower local health and care leaders to pursue new and innovative ways of delivering for the people and communities in each part of the country, and we support measures designed to promote further collaboration in systems and places. It’s important to recognise that ICBs and ICPs are still in their infancy, having been placed on a statutory footing less than a year ago, and are still finalising their first joint forward plans and integrated care strategies. We want to help ICSs to grow and develop in the self-supporting way that is envisaged in the review. But we need to consider further the most appropriate way of achieving this aim and how we can enable systems that are more advanced to go further and faster, giving them the flexibility and space to do this, whilst ensuring our approach is embedded across system partners. Ensuring that we maximise the ability to improve and make decisions for the most advanced systems is an important challenge as systems improve and mature. More work needs to be undertaken to consider how partnerships of the kind described in the Hewitt Review might work in practice.