• This new report shares lessons learned from a six-month collaboration between seven Integrated Care Systems. The programme encouraged ICSs to explore how they could improve health and care outcomes for the most excluded: people in ‘inclusion health’ groups. Pathway led the programme with support from our partners at Groundswell and The King’s Fund.  
  • People in inclusion health groups experience extremely poor health outcomes, with studies showing dramatically higher morbidity, comorbidity and mortality rates and shockingly low average ages of death compared to the general population. This programme explored what ICSs could do to make a difference, given their legal duties in relation both to integration and to addressing health inequalities. 
  • The collaboration looked at different ways ICSs could lead: to improve services, to include populations routinely excluded or invisible to the system, and to provide good quality integrated care beyond the ‘pockets’ of good practice we found in every geography.  
  • The findings were in line with the Hewitt Review’s recommendation that tackling inequalities should be core business.  
  • As one of our programme leaders, an NHS Trust Chief Executive, said at the outset of the collaboration: “if integrated care cannot tackle Inclusion Health, we should all be worried.” This project showed that ICSs have real opportunities to use their system overview, their convening powers and leadership roles, and their budget setting, to improve services for the most excluded and rapidly reduce the stark health inequalities they face. 

Inclusion health groups include people experiencing homelessness, vulnerable migrants, people engaged in sex work and Gypsy, Roma and Traveller Communities. When it comes to health they face a double whammy, suffering some of the worst health outcomes and experiencing poor access to the health and care services that would help them. The most recent ONS statistics showed the average age of death in 2021 for people identified as homeless was just 45 for men and 43 for women; 42% of English Gypsies have a long-term condition, as opposed to 18% of the general population. Just getting registered with primary care without an address remains a major challenge in many places. 

The establishment of Integrated Care Systems, with clear duties to address health inequalities and the theoretical power to really join up health and care services around people’s needs, represent a huge opportunity to reverse this situation.  

Last Autumn Pathway, the inclusion health charity, formed a partnership with Groundswell and The King’s Fund, and created a ground-breaking collaborative programme for seven ICSs from across England to explore the potential of these new systems for inclusion health groups. Through six learning and developmental sessions, we worked together to explore how ICSs could make change happen and improve outcomes for people in the most vulnerable and excluded communities. Expert contributors from the NHS, housing and social care shared multiple examples of evidence-based good practice, as well as their reflections on how to achieve the system change needed to make that progress a reality.  

The programme identified two commonly occurring patterns: firstly, the excellence of particular places or specific services in providing good quality care to a specific Inclusion Health population, while sitting alongside poorly developed services for other vulnerable populations; and secondly, the success of certain places in providing access and care to a high standard in one neighbourhood, without that leading to better quality on a bigger footprint. 

This report, presenting the lessons learned from the collaboration, suggests a number of steps that will help local systems build an evidence-based Inclusion Health route-map, in addition to presenting case studies of good practice and other learning from the programme. It can be downloaded here or by emailing us at info@pathway.org.uk.  

Our ICS partners all acknowledged that the new system is still in a formative stage, so the publication of this report is just the beginning. Pathway is now exploring the possibility of convening a second programme for a new cohort of ICS partners who want to go further in meeting the needs of their most poorly served populations.  

Additionally, we will be launching a specialist inclusion health network for system leaders and managers working within ICS leads to share knowledge and good practice on how to improve services for inclusion health populations. This new network will be hosted by the Faculty for Homeless and Inclusion Health, the multi-disciplinary national professional network hosted by Pathway and focused on health care for people experiencing homelessness and other excluded groups.  

The first online meeting is set for 11am on Friday 6 October, so if you work in Integrated Care and are interested in joining the network, please email us at faculty@pathway.org.uk.

Alex Bax, CEO of Pathway, said:

Integrated Care Systems are the opportunity we have long been waiting for to tackle the unacceptable health inequalities faced by some of our most vulnerable and excluded populations. For a long time, we have been aware of the excellent care offered in isolation to particular groups in particular localities. This report asks the questions of what makes good inclusion health, and how can leaders seek to replicate those successes across current universalist services?” 

Rachel Brennan, Participation and Progression Director for Groundswell, said:

Our work over the course of the programme with participants from seven regional ICSs provided us with critical insights into the challenges facing different inclusion health communities, inspirational examples of great practice, and a clear vision of the practical steps required and leadership necessary to fulfil the promise of integrated services.” 

Toby Lewis, Chief Executive of Rotherham, Doncaster and South Humber NHS Trust and former King’s Fund Senior Fellow, said:

We do not need to create the evidence on how to tackle Inclusion Health, nor to remake the case for why. Between last year’s NICE guidance on homelessness, and this new collaboration from leaders across seven Integrated Care Partnerships, brought to life in this report, we have the raw material to do. The ask of ICB top teams is to get stuck in in making sure that place partnerships are fully focused in 2024 on this opportunity to address longstanding inequalities.”