Neighbourhood Health

Key messages

• The review synthesised evidence from 62 local and international integrated care initiatives (29 included studies) and identified core domains for neighbourhood-level integration, including leadership roles, cross-sector partnership principles, integrated multidisciplinary teams, community-tailored priorities, and coordinated service delivery.
• Six common success factors emerged: co-located multidisciplinary teams, shared data systems, a preventive population health focus, population segmentation for targeted care, strong community input, and flexible governance, all linked to better coordinated, person-centred care.
• Co-location of services and shared decision-making among providers were associated with improved continuity and coordination, breaking down professional silos and improving experiences for people who use services.
• Equity outcomes were rarely measured, limiting conclusions about impacts on health inequalities and revealing a major evidence gap in equity measurement within integrated neighbourhood initiatives.
• Integration was most effective where systems had strong cross-sector relationships and pooled or aligned resources; lack of trust, fragmented funding and incompatible IT systems were major obstacles.

Policy implications

• Embed equity indicators in neighbourhood performance frameworks, using metrics that track outcomes by deprivation, ethnicity and other equity dimensions.
• Apply proportionate investment to neighbourhoods with the poorest health outcomes, directing more resources to areas with the greatest needs.
• Develop shared digital infrastructure so integrated teams can share information and identify inequities in access and outcomes in real time.
• Strengthen cross-sector leadership and governance that prioritise equity in service design and implementation.
• Commission long-term evaluations of neighbourhood care models that explicitly measure impacts on health inequalities.

Commentary

This review shows that integrated neighbourhood care models can support more coordinated and community-focused services, but also that equity has often been treated as an afterthought. Many initiatives improved coordination and access in general, yet rarely measured outcomes for underserved groups. Without equity metrics, it is difficult to know who is benefiting and who might be left behind.

From an equity perspective, neighbourhood integration should be used to reach people with unmet needs, for example isolated or high-risk residents, rather than only improving care for those already engaged. The evidence suggests that collaboration and co-location can improve person-centred care, but this will not automatically reduce inequalities without proportionate investment in poorer neighbourhoods, community co-design, and indicators that highlight differential outcomes.

The analysis suggests that integrated neighbourhood models need explicit equity goals built into their governance, funding and data. Integration on its own will not close health gaps; it needs to be combined with targeted resource allocation, equity-focused metrics and meaningful involvement of communities most affected by poor health and social conditions.

Key messages

• Successful neighbourhood-level integration depended on strong local leadership, clearly shared goals and effective communication across professional and organisational boundaries, helping NHS, local government and voluntary sector organisations work as one team.
• Common challenges included misaligned professional cultures and identities, silo working and technical barriers such as incompatible IT systems and difficulties in sharing data, which slowed referrals and coordination.
• Structural changes like new multi-agency teams or hubs mattered, but relational and cultural factors such as trust, collaboration and shared responsibility for people who use services were critical to making integration work.
• Practical strategies used included co-locating multidisciplinary teams, shared governance frameworks for decision-making and resource-sharing, joint training and regular cross-sector meetings to build mutual understanding.
• Sustaining integration was difficult with short-term funding and pilot status; longer-term support and adaptability (including during COVID-19, for example through digital collaboration tools) were important to maintain progress.

Key statistics

• The project reported anecdotal improvements such as better patient and community satisfaction, reduced duplication and faster decision-making; one case study described reduced waiting times for community support following joint triage meetings, although quantitative data were not collected consistently.

Policy implications

• Provide sustained, flexible funding for neighbourhood integration, including devolved or pooled budgets and investment in infrastructure such as IT systems and shared locations.
• Support shared governance and accountability frameworks for neighbourhood partnerships, giving integrated teams formal authority and clear responsibilities.
• Invest in workforce integration and cultural change, including joint training, cross-organisation roles and performance expectations that value collaboration.
• Enable data and information-sharing at local level by addressing legal and technical barriers and standardising agreements and interoperability.
• Encourage community participation and co-production in neighbourhood service design, including representation on neighbourhood boards and support for community development.

Commentary

The Neighbourhood Integration Project shows that joining up care locally is possible and can improve experiences, but it is complex and highly dependent on people and relationships. Integration worked best where local leaders built trust and a shared identity across organisations, so people who draw on care and support experienced one joined-up team rather than separate services.

The project also highlights that structural reforms and new teams are not enough on their own. Persistent cultural differences, mistrust and siloed ways of working can continue to fragment care. From an equity perspective, this matters because people with complex needs are most reliant on smooth coordination between services and are most affected when relationships and communication break down.

COVID-19 showed that local systems can adapt quickly and collaborate more closely when there is a shared sense of urgency. The challenge is to keep that momentum, maintain focus on disadvantaged groups and sustain integration beyond short-term projects. The lessons from these case studies provide practical pointers for neighbourhood teams and policymakers on how to build and protect this collaborative capacity.

Key messages

• Aligning organisational cultures and professional practices was a key workforce challenge; staff from NHS, local authorities and the voluntary sector often had different working styles and expectations that initially hindered teamwork.
• Workforce rigidity and siloed roles were addressed through new hybrid roles such as care navigators and community link workers, and through job-swaps and shadowing to build understanding across professions.
• Staff shortages and retention problems, especially in community and social care roles, put pressure on integrated teams; some areas used joint recruitment campaigns and development opportunities to attract and keep staff.
• Differing employment terms and management structures created complexity; co-location under a single operational lead and Memoranda of Understanding were used to create more unified day-to-day working.
• Joint training and continuous learning, for example multi-disciplinary workshops on holistic care planning, helped build a common knowledge base and strengthened mutual respect and collaboration.

Key statistics

• One locality reported a 20 per cent increase in staff feeling supported by colleagues from other agencies and reduced duplication of work after adopting an integrated workforce model, although most evidence was qualitative.
• Three local case studies illustrated workforce innovations such as pooled budgets for a single neighbourhood team manager, rotational posts across health and social care, and a joint training academy for integrated care skills.

Policy implications

• Develop frameworks for cross-sector workforce planning and development, including joint funding for community roles and, where feasible, pooled HR arrangements.
• Invest in training for integrated care competencies, such as interdisciplinary communication, care coordination and community engagement, and embed these in professional education and development.
• Support new integrated roles and career paths, with clear job descriptions, progression routes and fair pay for roles like care coordinators and community health workers.
• Facilitate secondments and joint appointments between organisations to break down institutional barriers and spread integrated working.
• Promote inclusive, community-reflective hiring so neighbourhood teams better reflect and build trust with the communities they serve.

Commentary

This briefing underlines that integrated care depends on integrated teams. Without attention to workforce cultures, roles and conditions, neighbourhood integration remains a structural ambition rather than an everyday reality.

The evidence shows that breaking down professional silos, creating cross-cutting roles and investing in joint training can improve coordination and support people with complex needs more effectively. From an equity perspective, a stable, community-connected workforce is better placed to notice and respond to local gaps in access and support, while fragmented teams risk leaving those with multiple needs to navigate services alone.

The examples presented suggest that workforce policy and HR practice are as important as organisational design in achieving integrated, equitable neighbourhood care. Ignoring these human factors can undermine even well-designed integration initiatives.

Key messages

• All four UK nations have long pursued integration to improve experience, quality, efficiency and population health, but progress has been slow and outcomes mixed, with limited evidence of major benefits for people using services.
• There is a mismatch between ambitious aims and what integration can realistically deliver; expected improvements in patient satisfaction, emergency admissions and delayed discharges have not been realised at scale.
• Data limitations and inconsistent metrics across countries make it difficult to assess impact; indicators such as emergency admissions and delayed transfers of care show, at best, modest and unsustained improvements.
• No country has demonstrated significant cost savings from integration; pooled budgets have not delivered strong evidence of system-wide financial gains.
• Repeated structural reforms have often overlooked local relationships, resources and culture; legal duties to collaborate have not been sufficient to create effective, trusting partnerships.

Key statistics

• Over 20 years of reform, patient satisfaction has not markedly improved and has sometimes fallen, despite integration policies.
• Delayed transfers of care improved briefly in parts of the UK but gains were not sustained; emergency admissions for older people did not fall.
• By 2020 all four countries had formal integrated structures (for example, 42 Integrated Care Systems in England and 31 integration authorities in Scotland), yet performance on key outcomes did not clearly improve in line with these changes.

Policy implications

• Set realistic expectations for integration, focusing on improving experience and coordination rather than promising quick cost savings or dramatic outcome gains.
• Invest in better data and evaluation, including balanced scorecards with patient-reported outcomes, experience, inequality metrics and utilisation.
• Focus on enabling conditions such as adequate social care funding, workforce capacity and aligned incentives, not only on new structures.
• Strengthen leadership and collaborative culture through joint leadership development and shared accountability frameworks.
• Embed equity goals explicitly in integration plans and reporting, so that reducing inequalities is a core objective rather than an implicit expectation.

Commentary

This report offers a realistic assessment of integration across the UK. It shows that structural change and pooled budgets alone have not delivered the expected improvements in outcomes or savings, and that underlying issues such as social care funding and workforce shortages limit what integration can achieve.

From an equity perspective, the findings suggest that integration needs to be paired with investment in community and social care services and with clear equity objectives. Without this, reforms risk reorganising systems without changing the experience of people with the greatest needs, including those who rely most on coordinated health and social care support.

The analysis highlights that integration is a long-term, relational process. For neighbourhood health, this means national policies need to support local systems with time, resources and clear but realistic goals, rather than expecting rapid, measurable gains across all indicators.

Key messages

• The study identifies three main barriers to integration: difficulties accessing social services, poor interprofessional relationships and infrastructural problems.
• Communication issues and siloed working cultures led to delays in referrals and fragmented care coordination.
• Inadequate interoperability between IT systems and lack of pooled budgets hindered cross-sector collaboration.
• Misaligned incentives between health and social care management reinforced divides and weakened efforts to build person-centred, integrated services.

Policy implications

• The findings highlight persistent systemic barriers to integration in London’s health and social care system.
• Priorities include improving interoperability of information systems, investing in shared training and interprofessional collaboration, and developing pooled funding models.
• Policy frameworks should promote joint accountability and remove incentives that maintain siloed working practices.

Limitations

• The research was limited to London GP surgeries, which may reduce generalisability to other areas.
• Social care perspectives were underrepresented, as participants were mainly long-serving primary care professionals.
• The cross-sectional design limits understanding of how integration challenges change over time.

Commentary

This study shows how structural and relational barriers between primary and social care can entrench inequities in access and experience. When communication fails or responsibility is blurred, people needing multi-agency support are most at risk of delays and gaps in care.

The findings highlight that fragmentation is not only an operational issue but also a distributive one: under-resourced areas and systems with weaker cross-sector collaboration are more likely to deliver disjointed care. Problems with IT, funding and incentives create variable local capacity to coordinate support, which in turn shapes neighbourhood-level inequalities.

The authors argue that integration policies must go beyond technical fixes and address power, culture and accountability. For integration to support equity, frontline professionals need shared governance, interoperable tools and incentives that support collaboration rather than reinforce organisational boundaries.

Key messages

• Older people and carers prioritised relational continuity, trust and personalised care, while providers focused more on coordination and system integration.
• Implementation was influenced by perceptions of interventions, organisational readiness, leadership and wider system enablers and barriers.
• Structural issues, such as complex care pathways, poor navigation and limited involvement of service users and carers, impeded integration.
• Contextual and cultural alignment across organisations was essential for sustainable integrated care for older people with frailty.

Policy implications

• Align policy and practice with the lived priorities of older people and carers, not only system efficiency goals.
• Promote co-production, joint accountability and investment in workforce training to support person-centred, trust-based care.
• Support adaptive, locally responsive implementation rather than rigid, top-down models, recognising variation in organisational readiness.

Limitations

• Most evidence came from high-income settings, limiting understanding of other contexts.
• Carer perspectives were underrepresented and socio-economic and ethnic diversity were not explored in depth.

Commentary

This review shows that for older people with frailty, integrated care must be relational as well as structural. People who use services value continuity, trust and personalised support, and may not experience system-level integration as positive if these elements are missing.

From a neighbourhood health perspective, integration works best when rooted in local networks of trust between professionals, communities and individuals. Where local relationships and navigation support are weak, older people face disjointed pathways and barriers to preventative and social support.

The review highlights that organisational readiness and alignment shape where integration is realised. Better resourced areas with stronger relationships are more able to build integrated, person-centred neighbourhood care, which raises concerns about geographical inequity in how older people experience integration.

Key messages

• Pooled budgets, strong local leadership and prior collaborative experience were critical in advancing integration across sectors.
• Sustainability and Transformation Partnerships illustrated the complexity of local integration processes and governance.
• Persistent inequalities existed across Greater Manchester’s ten localities, driven by differences in motivation, resources and capacity for collaboration.
• Recommendations included promoting shared leadership models, investing in collaborative infrastructure and addressing inequities in funding and capability.

Policy implications

• Adopt place-based integration models that combine shared governance with flexibility to respond to local contexts.
• Strengthen leadership capacity and cultivate a culture of collaboration to support equitable progress across localities.
• Reduce funding disparities, embed learning across local systems and develop mechanisms to prevent integration from widening gaps between better and worse resourced areas.

Limitations

• The focus on Greater Manchester may limit generalisability to other integrated care systems.
• Variation in local data and governance structures made comparisons difficult.
• The analysis emphasised organisational and policy perspectives rather than service user or community experiences.

Commentary

This study shows how integration is shaped by local histories, leadership and resource distribution. Areas with stronger relationships and pooled budgets were better placed to deliver integrated care, while others lagged, raising concerns about geographical inequity.

For neighbourhood health, the findings highlight that place-based integration can support more responsive care but may also amplify existing regional advantages if leadership and resources are uneven. Integration, therefore, needs deliberate strategies to support weaker systems, not only to empower those already ahead.

The analysis frames integration as a negotiated practice rather than a uniform policy process. It suggests that local governance must actively counterbalance differences in capacity and funding if integrated care is to support, rather than undermine, equity across neighbourhoods.

Key messages

• Integrated Care Systems (ICSs) have potential to address inequalities in healthcare access and the wider social determinants of health through collaboration with non-health partners.
• The place-based structure of ICSs supports local approaches that can integrate public health, social care and community assets.
• There is substantial variation in how ICSs define and operationalise equity; many plans lack specific strategies, measurable outcomes or detailed metrics.
• In several plans, equity is treated as a secondary rather than central priority, leading to inconsistent commitment and governance.

Policy implications

• ICSs offer a major opportunity to embed equity in integrated care, but this requires stronger national guidance and clearer accountability frameworks.
• Investment in local analytical capacity is needed so ICSs can measure and track progress on inequalities.
• ICSs should be required to develop measurable equity goals and to engage meaningfully with local authorities, voluntary organisations and communities.
• Without explicit targets and resources, there is a risk that health equity remains rhetorical rather than implemented in practice.

Limitations

• The study analyses plan documents rather than implementation data, capturing intentions rather than realised impact.
• Variations in plan quality and detail limit comparability, and longitudinal evaluation is needed to understand outcomes.

Commentary

This analysis highlights a gap between the potential of ICSs to reduce inequalities and the current strength of their plans. Many systems acknowledge equity but lack concrete strategies, metrics and governance arrangements to drive change.

For neighbourhood health, the place-based design of ICSs is important, but its impact depends on the depth of local partnerships and the priority given to addressing social determinants. The variability in plans suggests that some areas may move faster than others, risking further geographical inequalities.

The paper points to the need for equity to be a defining objective of ICS governance, supported by national expectations and local capacity. Without this, integration may improve coordination in general but fail to reduce disparities in access, experience and outcomes.

Key messages

• Neighbourhood integration depended on strong, visible leadership, shared objectives and clear communication across professional and organisational boundaries.
• Barriers included siloed professional cultures, differing identities and inconsistent data-sharing practices.
• Structural alignment was necessary, but relational and cultural factors such as trust, collaboration and shared purpose were critical for integration to work in practice.
• There was limited empirical evidence on what successful neighbourhood integration looks like in urban UK contexts.

Key statistics

• The rapid review did not report quantitative data or statistical measures.

Policy implications

• Use the findings to develop locally tailored strategies for neighbourhood integration in health and social care.
• Recognise that structural reforms alone are insufficient; investment in relational leadership, joint training and trust-building mechanisms is essential.
• Strengthen evaluation frameworks to include measurable outcomes, user perspectives and long-term follow-up.

Limitations

• There was a lack of empirical research and robust evaluation studies on neighbourhood integration in the UK.
• Service user, carer and frontline staff perspectives were limited, restricting understanding of lived experience.
• The focus on a single city context may limit generalisability.

Commentary

This review emphasises that neighbourhood integration is fundamentally relational and cultural. Leadership, shared purpose and trust were central to success, while professional silos and inconsistent information-sharing continued to fragment care.

From an equity angle, these relational dynamics translate directly into different experiences between neighbourhoods. Areas with stronger collaborative networks were more able to offer timely, coordinated support, while others risked perpetuating gaps in access and quality.

The report also highlights evidence gaps, particularly around service user and carer experiences. Without these perspectives, it is difficult to judge whether integration is improving equity in outcomes. The findings support a place-based approach where integration is used to build local relationships and shared ownership of goals, not only to reorganise structures.

Key messages

• Integration efforts have largely focused on individual-level services, with limited progress towards multi-level or multi-sector coordination.
• Broader determinants such as housing, social isolation and economic deprivation are increasingly recognised as critical for effective integration for older adults with multimorbidity.
• Policymakers need to allow time for integration to develop, so new structures, relationships and governance arrangements can mature.
• A tension remains between top-down frameworks and bottom-up initiatives, pointing to the need for whole-systems approaches that accommodate local flexibility.

Policy implications

• Develop integrated care strategies that reach beyond organisational boundaries to address social and environmental determinants of health.
• Support sustained, locally adaptive integration and avoid frequent restructuring that disrupts relationship-building.
• Ensure national reforms are sensitive to local contexts and do not undermine community-driven integration efforts.

Limitations

• There is limited empirical evidence of multi-level integration in England; most studies focus on specific service models or pilots.
• Robust evaluation data on long-term outcomes, especially equity and population health, are lacking.

Commentary

This review highlights a gap between policy rhetoric about whole-person, whole-system integration and the reality of practice, which remains focused on individual-level interventions. For older adults with multimorbidity, this means wider determinants such as housing and social isolation are often insufficiently addressed.

From an equity standpoint, integration that is confined to clinical and social care services is unlikely to reduce structural disadvantages affecting older people. The authors emphasise the need for time and stability so local relationships and governance can develop, warning that rapid restructuring without relational investment can entrench gaps between well-resourced and under-resourced systems.

The findings suggest that neighbourhood-level integration, grounded in local partnerships that span health, social care and community sectors, offers a route to addressing social determinants. However, this requires national policies that support local flexibility, provide sufficient resources and explicitly prioritise equitable outcomes.