How is the relationship between integrated working and health inequalities characterised in English Integrated Care Systems’ Strategy Documents (2022-2024)?

Background: Integrated care has been pursued globally as a means to improve people’s health and wellbeing, improve service efficiency and, more recently to address inequalities in health. In 2022 England’s National Health Service introduced Integrated Care Systems (ICSs): broad partnerships of health and care organisations given responsibility for planning local services, whose strategic aims include reducing health inequalities. This study will explore how ICS partners plan to work together on this issue, to gain insights into the role of integrated working in addressing health inequalities.

 

Approach: A structured document analysis of all 42 English ICSs’ Strategy Documents published between 2022 and 2024 was conducted. An inductive approach was taken in line with Grounded Theory methodology. Themes were identified and developed following line by line coding of all documents, with joint coding of some documents. This study is the first element of a PhD and will directly inform stakeholder and public involvement in the next phase.

 

Results: The analysis revealed the following key themes. ICS partners present integrated working on health inequalities as a necessity, reflecting that health inequalities are complex, multifactorial problems which they cannot solve alone. Local people and Voluntary, Community and Social Enterprise organisations are viewed as key partners in integrated working on health inequalities. Integration will primarily be organised on a geographical basis, with partnerships operating at ‘system’, ‘place’ and ‘neighbourhood’ level.

 

Partners plan to work together strategically (by sharing information and developing common priorities on health inequalities) and operationally (by delivering joined up health and care services to those in need). They intend to collaboratively address health inequalities by reducing inequalities in healthcare (focusing on access), maximising opportunities for prevention, and addressing the wider determinants of health (including housing and employment). Finally, ICSs suggest that specific groups might benefit from integrated working to address health inequalities, with emphasis given to children, young people and families, people with serious mental illness, learning disabilities or autism, and people from minoritised communities.

 

Implications: These findings illustrate how local care health and care leaders in England are interpreting a national policy requirement for integrated working to reduce health inequalities. Future work will explore how ICSs implement these ambitions in practice.