Health Foundation, 8 Salisbury Square, London, EC4Y 8AP, UK.
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
BMC Public Health. 2024 Sep 27;24(1):2613. doi: 10.1186/s12889-024-20089-5.
Policymakers across countries promote cross-sector collaboration as a route to improving health and health equity. In England, major health system reforms in 2022 established 42 integrated care systems (ICSs)-area-based partnerships between health care, social care, public health, and other sectors-to plan and coordinate local services. ICSs cover the whole of England and have been given explicit policy objectives to reduce health inequalities, alongside other national priorities.
We used qualitative methods to understand how local health care and social services organizations are collaborating to reduce health inequalities under England's reforms. We conducted in-depth interviews between August and December 2022-soon after the reforms were implemented-with 32 senior leaders from NHS, social care, public health, and community-based organizations in three ICSs experiencing high levels of socioeconomic deprivation. We used a framework based on international evidence on cross-sector collaboration to help analyse the data.
Leaders described strong commitment to working together to reduce health inequalities, but faced a combination of conceptual, cultural, capacity, and other challenges in doing so. A mix of factors shaped local collaboration-from how national policy aims are defined and understood, to the resources and relationships among local organizations to deliver them. These factors interact and have varying influence. The national policy context played a dominant role in shaping local collaboration experiences-frequently making it harder not easier. Organizational restructuring to establish ICSs also caused major disruption, with unintended effects on the partnership working it aimed to promote.
The major influences on cross-sector collaboration in England mirror key areas identified in international research, offering opportunities for learning between countries. But our data highlight the pervasive-frequently perverse-influence of national policy on local collaboration in England. National policymakers risked undermining their own reforms. Closer alignment between policy, process, and resources to reduce health inequalities is likely needed to avoid policy failure as ICSs evolve.
各国政策制定者都提倡跨部门合作，以此作为改善健康和健康公平的途径。在英国，2022 年的重大医疗体制改革建立了 42 个综合医疗系统（ICS）——这是医疗保健、社会关怀、公共卫生和其他部门之间基于区域的合作伙伴关系，旨在规划和协调当地服务。ICS 覆盖整个英格兰，并被赋予了明确的政策目标，即除了其他国家优先事项之外，还要减少健康不平等。
我们使用定性方法来了解在英格兰改革下，当地医疗保健和社会服务组织如何合作来减少健康不平等。我们在改革实施后不久（2022 年 8 月至 12 月），对三个 ICS 中经历高社会经济贫困水平的 NHS、社会关怀、公共卫生和社区组织的 32 位高级领导人进行了深入访谈。我们使用了一个基于国际跨部门合作证据的框架来帮助分析数据。
领导者们描述了对共同努力减少健康不平等的强烈承诺，但在这样做时面临着概念、文化、能力和其他挑战的组合。从国家政策目标的定义和理解方式，到交付这些目标的本地组织的资源和关系，各种因素共同塑造了本地合作。这些因素相互作用，具有不同的影响力。国家政策背景在塑造本地合作体验方面发挥了主导作用——经常使情况变得更加困难，而不是更容易。为建立 ICS 而进行的组织重组也造成了重大干扰，对其旨在促进的伙伴关系工作产生了意想不到的影响。
英格兰跨部门合作的主要影响因素与国际研究中确定的关键领域相吻合，为各国之间的学习提供了机会。但我们的数据突显了国家政策对英格兰本地合作的普遍影响——常常是适得其反的影响。国家政策制定者有可能破坏自己的改革。随着 ICS 的发展，需要更紧密地协调政策、流程和资源，以减少健康不平等，从而避免政策失败。
