From Rhetoric to Reality: Rebalancing Power, Trust and Legitimacy in Cross-Sector Collaboration within England’s Integrated Care Systems

Background: Health and care systems globally are facing unprecedented pressures, with the World Health Organization calling for a fundamental shift toward integrated, people-centred approaches. International policy increasingly recognises the Voluntary, Community and Social Enterprise (VCSE) sector as an integral part of local health systems and a strategic partner in improving population health. The establishment of 42 Integrated Care Systems (ICSs) in England aimed to create a “partnership of equals” across health, local government, and the Voluntary, Community and Social Enterprise (VCSE) sector.

Yet findings from, Rhetoric versus Reality (Phillips, 2025) and From Policy to Practice (James, 2025); both undertaken during the initial implementation of ICSs, underscore the importance of understanding local context and relational dynamics, particularly as these Integrated Care Boards (ICBs) now shift to larger footprints. They also find that while collaboration is strongly endorsed in policy, it remains inconsistently practised. With persistent power imbalances, tokenistic engagement, and limited mechanisms for trust and shared accountability, constraining genuine partnership. This workshop will explore how we can shift from lip-service to co-design to trust-based collaboration that fully values the VCSE sector as a system partner.

Approach: This 90-minute interactive workshop blends insights from both studies with participants’ experiences to co-design practical tools for rebalancing relationships within integrated care.

Activities include: Opening overview (15 min): Key findings from both studies on power, legitimacy, and trust in ICS–VCSE collaboration.

Understanding Persistent Asymmetry of Power (40 min):

Through group discussion of three real ICS–VCSE examples from recent research, participants explore why asymmetric relationships persist despite policy commitments to collaboration. Using a Power–Trust Reflection Framework, groups debate the gap between the rhetoric of co-design and the reality of co-working, identifying structural, cultural, and behavioural enablers of change.

Synthesis discussion (20 min): Shared reflections on what systemic, cultural, or policy shifts are needed to move from rhetoric to reality.

Action planning (15 min): Each group develops one actionable commitment to strengthen equitable partnership in their local system.

Over 70% of the session is action and discussion-based, using visual templates and peer learning to encourage reflection and application.

Results: / Expected Outcomes: Participants from across sectors, disciplines, and countries will gain practical insight into how accountability, legitimacy, and trust operate within integrated care partnerships. The session will challenge attendees to reflect on power dynamics, engagement practices, and assumptions within their experiences, moving from transactional involvement to shared purpose and mutual respect. By drawing on diverse experiences, it will surface common opportunities and challenges across contexts, generating transferable learning on system-wide governance, leadership, and the collective action needed to achieve sustainable, people-centred integration.

Implications: The workshop contributes to international learning on integrating civil society within formal health systems. By addressing the relational and structural foundations of collaboration, it supports systems to move from policy rhetoric to practice reality and build genuinely inclusive, community-led integrated care.