The Challenges Facing VCFSEs in Integrated Care Systems: A Qualitative Case Study of a Unitary Authority in England

Introduction: Integrated Care Systems (ICSs) in England seek ever-closer collaborative relationships between health and social care providers, local authorities, and the Voluntary, Community, Faith and Social Enterprise (VCFSE) sector to deliver public services in place. However, ICSs present significant challenges for VCFSEs.

Methods: In-depth qualitative case study of VCFSEs in an ICS contiguous with a Unitary Authority in England.

Results and Discussion: i) the role of the ‘microbiome’ of smallest VCFSE in the ICS is unclear; ii) current commissioning models work against the effective participation of VCFSEs in ICSs; iii) short-term and under-funded contracts threaten VCFSEs; iv) substitution and appropriation represent tangible threats to VCFSEs through increased demand and bureaucratisation; v) the degree to which ICS support a vibrant, heterogeneous, and sustainable VCFSE sector depends on ‘system maturity’.

Conclusions: Integration is a process, not an event. The evolving landscape of service design presents both opportunities and challenges for VCFSEs, requiring careful management to harness strategic advantages while addressing operational risks.