Robin Miller

Purpose: To explore the nature and realities of integrated care leadership through the perspectives of systems leaders and the theoretical lens of adaptive leadership. Design/methodology/approach: A qualitative methodology involving interviews and focus groups with twenty-seven participants from social care, health care, public health and lived experience. These participants were drawn from six integrated care systems (ICSs) within a single English region. Findings: Integration was seen as involving both technical (i.e. can be understood and addressed through existing knowledge and resources) and adaptive (i.e. requires learning new practices and behaviours) challenges. Integrated care required leaders to have both strategic (balcony) and operational (dance floor) perspectives, with national targets and priorities seen to limit opportunity for local patterns emerging. In general, ICSs were seen to not yet have the correct balance between balcony and dance floor. Anxiety was felt throughout, but in particular by people with lived experience and the voluntary and community sector who still felt unequal partners in their local systems. Research limitations/implications: This study was completed in one region of England and did not include those with practice roles. Practical implications: Integrated care leaders must embrace diverse perspectives in their thinking, planning and implementing through learning together about what works and what should be discarded. Enablers include national performance regimes emphasising holistic outcomes for people and communities, creation of shared data and improvement processes that work across sectors and national bodies, including professional associations, supporting the necessity, scale and pace of change required. Originality/value: This research shares the experiences of senior leaders of integrated care at a time of considerable policy turbulence and demand pressures and deploys the theoretical lens of adaptive leadership.

Background: To address health inequalities and deliver services more effectively, there is increasing interest internationally on integrated care better connecting with communities, including those based around geographic localities and / or shared culture and faiths. This has the potential to ensure that integrated care better responds to the needs and interests of community members and support builds on informal assets based around social networks, place-based resources, and cultural capital. However, there is evidence that rather than co-producing with communities, integrated care developments can impose their structure and processes. This workshop will explore the opportunities and tensions in relation to community-orientated integrated care.Audience: The workshop seeks to engage professionals from a wide range of backgrounds who are interested in inter-professional community-based approaches, people with lived experience of health and social care, and voluntary and community organisations. This will bring a variety of experience and insights regarding the value of inter-professional teams and their engagement with communities.Approach: The workshop will begin with a short overview of the rationale and interest in community-based approaches to integrated care and the current evidence in relation to their impacts and implementation. The process of the workshop will also be introduced.There will then be a short address by a community member with experience of integrated care as to what matters to them in relation to support from health and care agencies and professions.Participants will be organised into table groups which reflect a diversity of professional backgrounds and countries. For each question, half the group will be asked to rotate to the next table to enable new connections.The workshops will be configured around three topics which are set out below – for each topic there will be concise example of an integrated care approach which has sought to respond to this aspect (and if the workshop is chosen for a 90 minutes slot then this would allow a second example too).These will be followed by facilitated discussion on tables with the main points of discussion being captured by a note taker.The topics (which have been shaped in discussion with a lived experience group) are as follows:1) How can integrated care better understand what is important to diverse communities?2) How can integrated care support and build upon assets within communities?3) What are the skills and knowledge needed by professionals and communities to build a successful collaboration.There is already interest in sharing examples at the workshop from South Africa, UK and Australia.The workshop will end with 1 point being shared from each table and final thoughts from the workshop chair and the community member with lived experience.Outcomes: Participants will leave with a better understanding of community orientated approaches to integrated care, the related enablers and barriers and with connections with new people.The notes will be used as the basis for a blog and / or perspective piece looking at community orientated integrated care.

A notable development in recent years has been the emphasis on structuring integrated care around ‘neighbourhoods’ or ‘places’ and engaging ‘communities’ in the planning, design and delivery of support. Across the world, related principles are being used to inform national and regional policies and to develop local practice innovations. Despite such interest, community and neighbourhood working can feel a radical endeavour which clashes with established structures, relationships, investments and skills. A group of international experts from policy, practice, communities and research came together at a roundtable at the International Conference on Integrated Care 2026 to debate how integrated care can authentically adopt these principles. Agreeing what is meant by such concepts and how they can be utilised in practice is an important starting point – ‘neighbourhoods’ were generally seen to be more geographically oriented and where people physically live, whereas ‘communities’ relate to the connections and relationships which matter to people. Addressing power and resource imbalances requires investing in the voluntary and community sector and framing neighbourhoods as the responsibility of the whole system, including hospitals. Building the professional skills and capacity for neighbourhood working means embedding as a core competency with qualifying and on-going education. Creating the organisational and system capacities to sustain involves developing performance metrics and processes which emphasis shared outcomes. Such developments also require researchers to support with the process of change through responsive, co-produced and accessible methodologies.

Background Strengths-based practice (SBP) shifts the focus away from a deficits approach to explore people’s potential to achieve personal outcomes, wellbeing, and promotes independence through collaborative conversations. To date, little evidence exists on how strengths-based practice relates to older people from black and minority ethnic communities. This qualitative systematic review aimed to explore how strengths and assets in the lives of older people from minority ethnic communities mapped against core elements of SBP in social care, and identify implications for practice. Method A qualitative systematic review of the literature was conducted, with studies appraised using the Critical Appraisal Skills Programme (CASP). An abductive approach was adopted to the data extraction and synthesis. Results Eleven articles were included in total – these were largely completed in England with single studies incorporating Scotland and Wales, with communities including South Asian, East Asian, African, Caribbean, Easter European, Gypsy and Travellers. None of the studies referred to specific SBP interventions in relation to older people from minority ethnic communities but did consider strengths-based principles. Important factors shared by older people within black and minority ethnic communities in relation to their wellbeing, had similarities with that of the general population including dignity, self-respect, security, and social connection, with these often built on a personal, familial and community strengths. A common aspect across many ethnic minority communities was the importance of faith and religion, and the need to have a valued role. A further pertinent finding was a lack of culturally appropriate statutory services that meet the needs of older people. Conclusions The principles of SBP will remain a focus for social care services through their correlation to core values of practitioners, older people’s aspiration to maintain connections and autonomy and the recognition that state funded services will struggle to meet increasing demands due to ageing populations with multiple health and care needs. Twinned with the increasing proportion of older people in the UK from black and minority ethnic communities, this means that a better understanding of what contributes to their wellbeing will be crucial if services are to build on their strengths and provide culturally appropriate support.

Background: Despite attempts to reduce the use of modern secure specialist hospitals (long‐stay hospitals) for people with intellectual disabilities and/or autistic people, there remains a limited understanding of what happens after discharge. Method: Systematic review of outcomes following resettlement from UK long‐stay hospitals. Results: Outcomes generally improve following resettlement, although some soon level off and rarely reach the level of comparable populations. We still know little about service costs or about how many readmissions/reconvictions to expect given the complexity of people's needs and such rates in other settings. Above all, most studies fail to meaningfully include the voices of people themselves. Conclusions: Outcomes improve after hospital, but this is not guaranteed and even improved outcomes may still not be good enough. Future research should aim to fill a number of gaps in current knowledge—but in particular must draw much more meaningfully on the lived experience of people and families.

This article details a correction to: Michgelsen J, Zonneveld N, Miller R, Stein V, Longpré C, Jubinville M, et al. Navigating a Decade of Integrated Care Research in the International Journal of Integrated Care: How Far Have We Come? International Journal of Integrated Care. 2025;25(3):25. DOI: https://doi.org/10.5334/ijic.9086

Background The strengths-based approach (SBP) shifts the focus away from a deficits approach to explore people’s potential to achieve personal outcomes, wellbeing, and promotes independence through collaborative conversations. Unfortunately, little evidence exists on how strengths-based practice relates to older people from black and minority ethnic communities. This qualitative systematic review aimed to explore how strengths and assets in the lives of older people from minority ethnic communities mapped against core elements of SBP in social care, and identify implications for practice. Method A systematic search and review of the literature was conducted, with the qualitative studies appraised using the Critical Appraisal Skills Programme (CASP). An abductive approach was adopted to the data extraction and synthesis. Results None of the studies referred to SBP in relation to older people from minority ethnic communities. The review tended to emphasis factors which negatively influenced people’s wellbeing rather than strengths per se. but were included in order to recognise the difficulties which people face, and the structural nature of these is a core aspect of SBP. Important factors shared by older people within black and minority ethnic communities in relation to their wellbeing, had similarities with that of the general population including dignity, self-respect, security, and social connection, with these often built on a personal, familial and community strengths. A common aspect across many ethnic minority communities was the importance of faith and religion, and the need to have a valued role. A further pertinent finding was a lack of culturally appropriate statutory services that meet the needs of older people. Conclusions The principles of SBP will remain a focus for social care services through their correlation to values of practitioners, and the recognition that state funded services will not be able to meet increasing demands due to ageing populations with multiple health and care needs. Twinned with the increasing proportion of older people in the UK from black and minority ethnic communities, this means that a better understanding of what contributes to their wellbeing will be crucial if services are to build on their strengths and provide culturally appropriate support.

Hospital-at-Home (HaH) delivers hospital-level treatment in the home, whether people’s own dwelling or a care home. Its intention is to replicate medical interventions available in hospitals in familiar and less distressing surroundings for older people and better coordinate care around the needs of the individuals and their unpaid carers. This study set out to hear directly from those most closely involved, older people themselves, the unpaid carers who support them, and the professionals delivering the service. Drawing on forty-three in-depth interviews, the research highlights both advantages and tensions within the model. Many participants described HaH as respectful, personal, and more attentive than hospital care. Carers welcomed the speed and attentiveness of the service but often found their responsibilities increased, sometimes to a challenging degree. Professionals valued the opportunity to work in a more person-centred way while also pointing to practical obstacles around risk, resources, and coordination with wider services.