(Dis)Integrated Care? Lessons from East London

Area of Science:

• Health Services Research
• Integrated Care Systems
• Qualitative Evaluation Methods

Background:

• Examined an Integrated Care Pioneers programme in East London involving commissioners, providers, and local authorities.
• Focused on a whole-person care model and the translation of an ambitious vision into on-the-ground delivery.
• Explored micro-mechanisms of integrated care relationships through the experiences of health and social care professionals.

Observation:

• Employed a participatory Researcher in Residence model, embedding the evaluator within organisations.
• Utilized qualitative methods including documentary analysis, observations, interviews, and coproduction workshops.
• Focused on understanding collaboration, shared learning, and addressing power imbalances among stakeholders.

Findings:

• Revealed persistent organisational fragmentation despite integration rhetoric and senior-level vision.
• Identified barriers between acute and community services, and difficulties in staff collaboration due to professional, cultural, and organisational differences.
• Noted a lack of capacity and support for genuine multidisciplinary approaches, despite widespread embrace of multiagency ethos.

Implications:

• Organisational leaders' actions had limited tangible impact due to misaligned priorities and structural incentives favouring competition.
• Staff experienced confusion regarding service functions and lacked influence in change processes amidst continuous reconfigurations.
• Recommended investing in bottom-up approaches to ensure cultural transformation reflects organisational capacity and addresses local needs.