Key findings

• Finance, joint forward planning and workforce depletion are among the main challenges for integrated care boards as people struggle to access the care they need.
• Urgent and emergency care services in crisis are a symptom of complex system problems that need resolving, by providing more services for people away from hospitals.
• Systems are focused on tackling health and care inequalities. They need to understand their populations to address issues that affect everyone, from children who need dental care to older people with dementia, but they face financial pressures and competing priorities.
• There are mixed views among integrated care systems (ICSs) about their capability to address local health inequalities. There are challenges and barriers around data and analysis skills, governance and accountability, and capacity and capability in the system.
• At all the local authorities we have assessed so far, there is work needed to identify carers and raise awareness that carers are entitled to an assessment and services to support them in their role – this was needed more for people in ethnic minority groups.
• Local authorities have taken steps to address known inequalities and understand the demographics of local populations. But there is a need for better engagement with the voluntary sector and community groups, which have seen some success in identifying groups that are seldom heard and at greater risk of inequality.
• Local authorities have a focus on safety through collaboration. Shared data and information is helping this, as it is made available across services and care pathways, improving safety for people moving between hospitals and the community.