REPORT Local authority engagement in Integrated Care Systems – Housing and Place-Based Partnerships

Executive Summary

The statutory introduction of Integrated Care Systems (ICSs) following the Health and Care Act (2022) has formally aligned local government with health partners through representation at Integrated Care Board (ICB) level, and the formation of joint committees in Integrated Care Partnerships (ICPs). While these new governance arrangements are relatively clear, the implications for those at operational levels are less straightforward or understood. Local authorities (LAs) now need to collaborate with a complex range of partners and stakeholders from a variety of sectors and contexts, and the extent to which this complexity can be negotiated and the means through which this takes place, has comprised a central aspect of this research.

Most local authorities provide socially rented housing either through their own housing stock, or via an Arms Length Management Organisation (ALMO). Housing associations can also provide social housing, although the terms for qualifying for local authority or housing association housing may differ for each organisation. Poor housing conditions (including lack of housing, or poor quality housing) has long been established as a key determinant of health. For example, evidence indicates that overcrowding, affordability, housing service provisions, insecurity of tenure, neighbourhood, and homelessness can all contribute to poorer physical and mental health outcomes, and can worsen health inequalities (Marmot et al., 2020, Rolfe et al, 2020; Tinson & Clair, 2020; Clair & Hughes, 2019). As such, it is critical for housing services to be better aligned with health services in order to provide better quality, joined up support to those in receipt of socially rented housing.

Through the collection of semi-structured interview data with 19 selected local authority and third sector staff and subsequent thematic analysis, the following seven themes have emerged: Type and extent of collaboration; Local Authority structure; Geography; Funding; Housing; Barriers to collaboration or integration; Factors that facilitate collaboration.

The findings revealed a high level of variability relating to the quality and nature of the collaboration taking place. Although Place-Based Partnerships (PBPs) have enabled new connections to be made across sectors, the extent to which this can occur will be influenced and, in some cases, restricted, by the type of LA (unitary/district), and the representative dynamics within LAs themselves.  

There were also disparities in relation to the perception of place. Although PBPs were generally well regarded by participants there were suggestions that in the context of the ICS they sometimes failed to truly represent the ‘places’ to which they were aligned. 

Funding was seen as a key factor which inhibits collaboration between LAs themselves and cross sector partners. A chronic lack of resources for LAs was consistently referred to, however there was evidence to suggest that innovative collaborative activity has provided some short-term responses to financial limitations. The issue does remain endemic though.     

Despite good housing being widely recognised as a key social determinant of health and a strong potential area for crossover within an ICS, there were frequent suggestions that the significance of housing has not been fully understood across ICS partnerships. There were also disparities between LAs who owned their own housing stock and those who worked alongside a housing association, the latter required to engage in an additional level of collaboration which was often of variable quality and efficacy.  

Overt barriers to effective collaboration included: healthcare centrism which was seen as pervasive. A lack of consensus around roles and responsibilities of partners. Fundamental cultural and operational distinction between LA and health partners, including terminological and linguistic ambiguities. Issues with communication and data sharing across sectors. Complexity of both ICS and NHS structure and chronic discontinuity ranging from political short-termism to frequent personnel changes. 

There were however some facilitators of collaboration described. These included the utilisation of the Covid-19 crisis to quickly and responsively provide innovative housing services with a range of partners. Good leadership was also deemed very important, in addition to wider stakeholder engagement and piloting smaller scale projects.