In this insight, Sam James reflects on ICIC26 in Birmingham, exploring why relationships, trust and shared power are fundamental to integrated care, and what health systems can learn from community-led approaches across different countries.
The International Conference on Integrated Care brings together people from across health, social care, research and the voluntary sector, all trying to answer the same question: what does it really take to make integrated care work?
After a few days of sessions, roundtables and conversations, one thing became clear:
The most interesting conversations weren’t about systems at all. They were about people. About trust. And about who actually holds the power to make decisions.
In England, we’ve spent years restructuring, integrating, reforming. But what stood out wasn’t one model or solution; across sessions, countries and contexts, the same message kept surfacing: getting the structure right is important, but it’s what happens around it that really makes the difference.
As someone who works in the non-profit sector and advocates for community-led approaches to integrated care, what struck me most was how many others were grappling with the same questions, and reaching similar conclusions.
So what actually makes integrated care work?
Relationships matter more than structures
There was a moment in one session where a speaker from Scotland reflected on over a decade of integrated care structures. The system hadn’t fundamentally changed, but outcomes had gone through cycles of working well, then not, then well again.
The difference? Not the structure. The relationships within it.
In contrast, colleagues in England spoke about constant reform. New models, new terminology, new expectations, every few years. The result is a system that never quite has time to settle, build trust, or learn.
Integrated care isn’t just technical. It’s relational. And relationships take time.
Shifting power, not just inviting participation
We often talk about “engaging communities” or “including the voluntary sector.” But many of the examples shared went further than that.
In Canada and Scotland, we heard about:
- Mandated community representation in decision-making bodies
- Voting rights for third sector and lived experience representatives
- Leadership roles held by community organisations, not just hospitals
This isn’t about better engagement. It’s about redistributing power.
Because without that shift, collaboration risks becoming performative, something done to or with communities, rather than alongside them.
Funding matters, but how it flows matters more
Of course, funding came up in almost every discussion. But not always in the way you might expect. The biggest barrier wasn’t the amount of money. It was the mechanism.
Competitive commissioning, in particular, was highlighted as actively harmful; fragmenting relationships, undermining trust, and discouraging collaboration.
In contrast, examples of collaborative or pooled approaches showed promise, but only where they were designed carefully and aligned with local relationships.
The takeaway?
It’s not just where money sits. It’s how it moves.
Rethinking what “success” looks like
One of the strongest themes across the sessions was how often we define success from a system perspective, not a human one.
Take neighbourhood hubs.
From a system lens, success might look like:
- reduced GP appointments
- fewer A&E attendances
- streamlined pathways
But in practice, the examples that worked best started somewhere else entirely.
They started with what people actually asked for:
- a place they already trusted
- somewhere local they could walk into
- a single point of contact to help them navigate support
In many cases, these weren’t health buildings at all, they were community spaces, led by the voluntary sector.
Success, then, was about creating places people wanted to go, connect with others, and build their own networks, which, over time, reduces demand on the public sector.
That shift changes the question completely:
Are we designing systems to manage pressure, while missing the point?
What I’m taking away
As well as a long list of amazing people I’m now connected to and inspired by, one thing the conference reinforced is this: we already know what works.
Across countries and systems, integrated care is at its strongest when it’s rooted in relationships, trust and communities.
The task now is not to redesign, but to back those approaches, learn from them, and allow them to grow.
Because integrated care doesn’t happen through structures alone.
It happens through people.
This blog builds on a workshop I co-led with Chris Phillips and Aimie Cole, “From Rhetoric to Reality”, alongside my insights from across the conference.
Sam James
NAVCA
Championing VCSE integration in health systems and community-led approaches to better health