This study uses the term inequalities. In this Evidence Hub, inequities is used where differences in access or outcomes reflect avoidable and unfair structural barriers in health and social care. 

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This study explores practical ways to address inequalities in dementia diagnosis and care through a national consultation involving people with dementia, carers, professionals and community organisations. The consultation involved 131 stakeholders who participated in workshops across England to discuss the barriers people face and identify possible solutions. 

The findings show that inequalities in dementia care arise from multiple interacting factors. These include individual circumstances such as income or ethnicity, community-level influences such as stigma or limited social support, and wider structural issues such as service availability and coordination between health and social care systems. 

Many of the proposed solutions focused on improving support after diagnosis. Stakeholders highlighted the potential role of dementia link workers or care navigators who could help people and their families understand their diagnosis, navigate services and access appropriate support. These roles could help address some of the structural barriers that currently create inequities in access to care. 

Community engagement was also identified as important. Participants emphasised the role of dementia-friendly communities, peer networks and local organisations in raising awareness and reducing stigma. Improving understanding of dementia within communities may encourage earlier help-seeking and improve access to support. 

Workforce development was another key theme. Stakeholders identified the need for better training for health and social care professionals, as well as clearer career pathways within the social care workforce. Improving workforce knowledge and stability may help reduce inequities in the quality and availability of dementia services. 

From a care equity perspective, the study highlights that inequalities in dementia care often reflect avoidable structural barriers within systems and services. These inequities can affect who receives a diagnosis, how quickly support is provided and the quality of care available after diagnosis. 

Overall, the study suggests that reducing inequities in dementia care requires coordinated action across multiple levels. Interventions targeting individuals, communities and health and social care systems need to work together to ensure that people living with dementia can access timely diagnosis and appropriate support regardless of their background or location. 

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This report positions community participation as a foundational element of neighbourhood health and care. By emphasising co-production and asset-based approaches, it reframes integration as something built with communities rather than delivered to them.

The case studies illustrate how engaging residents can improve trust, relevance and responsiveness of services. From a care equity perspective, these approaches are particularly important for addressing social determinants of health that sit beyond the reach of clinical services alone.

The report also highlights the role of voluntary and community organisations as connectors between statutory services and local populations. Their involvement can support prevention, early intervention and more holistic responses to need.

However, the evidence base remains largely qualitative. While the principles are clearly articulated, there is limited evaluative data on outcomes or how community-powered approaches reduce inequalities over time. For neighbourhood health and care, this underlines the importance of pairing community participation with robust evaluation to understand impact and sustainability.

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This interim report provides early insights into how commissioning and service design are shaping integrated neighbourhood health and care in England. By focusing on Place-level mechanisms, it highlights how national policy intentions are being interpreted and operationalised in local systems.

The shift towards neighbourhood-based integrated commissioning is situated within broader NHS reforms, including the 10 Year Health Plan and statutory establishment of Integrated Care Systems (ICS). In this context, Place offers a scale at which health and social care services can be joined up around people’s needs rather than organisational boundaries.

Key enabling factors identified in the literature signal that commissioning for integrated neighbourhood care requires more than structural arrangements; it depends on trust, shared priorities, effective governance and aligned incentives. These relational and organisational elements mirror themes seen in other neighbourhood health evidence that integration is as much cultural as structural.

However, the report also underscores the early and uneven nature of Place-level commissioning practice. With permissive policy frameworks and variable local interpretation, there is a risk that integrated neighbourhood services remain patchy in reach and impact. Strengthening evidence on what works, for whom, and in what contexts will be essential to ensure that neighbourhood health and care contributes to equity rather than reproducing existing disparities.

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This paper highlights the ambition within integrated care systems to address health inequalities through place-based and integrated approaches. The neighbourhood focus and emphasis on cross-sector collaboration provide a foundation for tackling not only access to services, but also the wider social determinants that shape health outcomes.

However, the analysis reveals uneven commitment and capacity across systems. While some integrated care systems articulate clear intentions around equity, others lack detailed strategies or measurable goals. From a care equity perspective, this variability risks reinforcing geographic disparities rather than reducing them.

The findings also suggest that collaboration with non-health partners is inconsistent. Where partnerships are underdeveloped, opportunities to influence housing, employment and community infrastructure may be missed, limiting the potential impact of neighbourhood health and care.

Importantly, the paper raises questions about whether equity is driving system design or being addressed retrospectively. Without embedding equity as a core organising principle, integrated care systems may struggle to translate place-based working into meaningful reductions in inequality.

Overall, the study indicates that neighbourhood health and care has significant potential to support equity, but this depends on the depth of strategic commitment, clarity of measurement and the strength of cross-sector partnerships within integrated care systems.

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This realist evaluation explores how national end of life care policy in England shapes the experiences of older people nearing death. The study highlights the complexity of translating national policy into consistent local practice. 

Patient experience at the end of life is shaped by a combination of formal services and informal care. Interviews with patients and families emphasised the importance of compassion, dignity and social connection during the final stages of life. Many patients expressed a preference to remain in familiar environments such as their home or care home rather than being admitted to hospital. 

However, the study found that achieving these preferences often depends on the availability of community-based services. Shortages of community nursing, limited overnight palliative care support and inconsistent access to home visits from clinicians were identified as barriers to delivering care outside hospital settings. 

Variation in service provision between local areas was a recurring theme. Differences in commissioning decisions, local budgets and organisational structures meant that some areas offered more comprehensive services than others. For example, variation in spending on end of life care between clinical commissioning groups suggests that resource allocation may influence the quality and availability of services. 

The research also highlights the fragmented relationship between health and social care systems. Medical care, such as pain management, is typically funded through the NHS, while practical and relational support such as personal care is often provided through social care services. Because these services operate under different budgets and governance structures, patients may experience gaps in support. 

The study emphasises that policy alone cannot guarantee equitable care. Successful implementation requires alignment between national policy goals, local commissioning decisions and the priorities of professionals, patients and families. 

From a health and social care equity perspective, the findings illustrate how geographical variation in services contributes to unequal care experiences at the end of life. Addressing these disparities will require stronger integration between health and social care systems, better support for the social care workforce and clearer mechanisms to reduce local variation in service provision.

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This study explores how geographical location and socioeconomic disadvantage shape access to palliative and end-of-life care in rural, coastal and low-income communities in southwest England. The South West Peninsula has one of the oldest populations in England, with more than a quarter of residents aged 65 or older. This ageing population increases the need for palliative care and community support services. 

People living in rural and coastal areas often face practical barriers to accessing care. Services may be located far from where people live, and public transport options can be limited. For people with serious illness or reduced mobility, travelling long distances for care can be particularly difficult. These barriers can delay access to support or make it harder for people to receive care in their preferred setting. 

Economic disadvantage can further increase these challenges. Some rural and coastal communities experience higher levels of deprivation alongside limited service availability. This combination can make it harder for individuals and families to access consistent and high-quality end-of-life care. 

The study highlights the value of working directly with local communities when planning services. Through partnerships between researchers, healthcare providers and community organisations, the project gathered insights into the specific needs and priorities of different communities. This approach helped identify gaps in services and possible ways to improve care delivery. 

From a care equity perspective, the findings show how location can shape access to health and social care services. People living in rural and coastal communities may experience structural barriers that are less common in urban areas. Without targeted policies and investment, these barriers can lead to inequities in access to palliative care and support at the end of life. 

Overall, the report suggests that improving palliative care access requires locally tailored solutions. Strengthening community services, improving transport and addressing workforce shortages could help ensure that people living in rural and coastal areas receive equitable support at the end of life.

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This report examines how stronger partnerships between housing, health and social care organisations can improve people’s wellbeing and reduce pressure on public services. It is based on interviews with fifteen collaborative projects across Wales that are already working across these sectors. 

The report highlights the strong link between housing conditions and health. Poor housing, including cold, damp or unsafe homes, contributes to illness and increases demand for health services. The report estimates that poor housing costs the NHS in Wales more than £95 million each year in treatment costs, with wider social costs exceeding £1 billion annually. 

One of the central ideas in the report is that housing should be considered part of the health and social care system. For example, some projects included housing staff working directly in hospitals to help patients resolve housing issues before discharge. Others used social prescribing approaches or integrated community hubs where multiple services work together to support people. 

These partnership models aim to help people stay in their homes safely and independently. This can prevent avoidable hospital admissions, reduce delayed discharges and improve quality of life. The report also highlights how joint funding and shared leadership can support these approaches. 

From an equity perspective, housing conditions play an important role in shaping health and social care outcomes. People living in poor-quality or unstable housing are more likely to experience health problems and require additional support. These challenges are often concentrated in lower-income communities, meaning housing can act as a driver of wider health and social care inequities. 

The report argues that stronger partnerships between housing, health and social care organisations can help address these issues. By coordinating services and focusing on prevention, integrated approaches may help reduce avoidable pressures on the health and social care system while improving outcomes for individuals and communities.

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This parliamentary inquiry highlights the challenges faced by people living in rural communities when accessing health and social care services. Around 9.7 million people live in rural areas in England, many in small villages and isolated communities where services are more spread out. 

Distance is one of the main barriers. People in rural areas often have to travel further to reach hospitals, GP services or social care support. Public transport options are often limited, meaning access to care may depend on having a car or support from family members. These barriers can be particularly difficult for older people, people with disabilities and unpaid carers. 

Workforce shortages also contribute to care inequities in rural areas. Health and social care providers often find it harder to recruit and retain staff in rural locations. Staff may need to travel long distances between patients, and smaller local services may struggle to maintain stable teams. 

Funding arrangements can reinforce these inequities. Delivering services across large rural areas is often more expensive, but existing funding systems do not always account for these additional costs. As a result, services in rural areas may receive fewer resources relative to the challenges they face. 

Another issue highlighted in the report is that rural disadvantage is often less visible in national statistics. Because poverty and health needs are more dispersed across rural communities, they may not appear clearly in standard deprivation measures. This can make it harder for policymakers to identify where support is needed. 

Overall, the inquiry argues that addressing rural care inequities requires policies that recognise the specific challenges of rural areas. Improvements in funding, workforce support, transport and community-based services are needed to ensure that people living in rural communities can access health and social care on fair terms. 

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This review highlights differing priorities among stakeholders involved in integrated care for older people with frailty. People who draw on care and carers place greatest value on trust, continuity and relationships, while providers focus more on coordination and system efficiency. From a neighbourhood health and care perspective, this misalignment has important implications for how integration is experienced on the ground.

Complex care needs and difficulties navigating fragmented systems create significant barriers for older people with frailty. Where neighbourhood models focus primarily on organisational integration without addressing relational aspects of care, they may fail to meet what people who draw on care value most.

The review also points to limited involvement of people who draw on care and carers in decision-making. This represents an equity issue, as neighbourhood health and care aims to tailor services to local needs but risks reproducing top-down approaches if co-production is weak.

Organisational readiness and wider system constraints shape whether integrated care initiatives can be implemented effectively. Without attention to workforce capacity, governance and system alignment, neighbourhood approaches may struggle to deliver meaningful change.

Overall, the findings suggest that equitable neighbourhood health and care for people with frailty requires integration that is both relational and structural. Aligning system coordination with continuity, trust and meaningful involvement of people who draw on care is central to achieving person-centred and equitable outcomes.

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This programme learning highlights workforce integration as a central enabler of neighbourhood-level care. Strong relationships across health, social care and community organisations underpin the ability to deliver integrated, person-centred services.

Co-located teams and shared leadership arrangements are identified as practical mechanisms for overcoming workforce fragmentation. From a care equity perspective, these approaches can improve continuity and responsiveness, particularly for people with complex or multiple needs.

However, the findings also point to structural risks. Short-term and inconsistent funding, fragmented data sharing and limited investment in community infrastructure constrain the sustainability of neighbourhood integration efforts. These barriers may disproportionately affect deprived areas, where services are already under pressure.

The learning also raises important equity considerations around trust. High levels of integration with statutory services can risk weakening the independence and trust of community-led organisations if not carefully managed. In neighbourhoods where communities have historically felt let down by formal systems, this may undermine engagement rather than strengthen it.

Overall, the evidence suggests that neighbourhood integration depends as much on relational and cultural factors as on formal structures. Ensuring that workforce integration supports, rather than displaces, community leadership is likely to be critical for delivering equitable neighbourhood health and care.

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This report draws on learning from a national inclusion health leadership programme involving Integrated Care Systems and partner organisations. It explores how collaborative approaches can improve outcomes for people experiencing severe social exclusion. 

The report highlights that inclusion health groups, including people experiencing homelessness and other forms of extreme marginalisation, often face complex and overlapping health and social needs. Fragmented services and poor coordination across sectors can make it difficult for individuals to access consistent care and support. 

A central theme of the report is the importance of collaboration across organisations. Integrated working between health services, social care, housing providers and voluntary sector organisations is presented as a key mechanism for addressing the structural drivers of exclusion and improving service access. 

From a care equity perspective, the findings emphasise that people experiencing the most severe forms of exclusion often face the greatest barriers to accessing health and care services. Without targeted action, these populations risk remaining outside mainstream service pathways and continuing to experience poorer health and care outcomes. 

The report suggests that progress requires leadership at both national and local levels. Strategic commitment, improved data, stronger partnerships and meaningful involvement of people with lived experience are identified as essential components for reducing inequities in access to care and improving outcomes for inclusion health groups. 

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This case study shows how housing conditions directly affect health and social care outcomes. The Healthy Housing Hub targets people whose living environments put them at risk, including older adults, people with long-term conditions and those on low incomes. 

The findings show clear reductions in emergency care use and hospital admissions. Improvements to heating, safety and home conditions appear to reduce risks such as falls, illness and delayed hospital discharge. The data presented in the evaluation summary highlights the scale of these changes, including reductions in A&E use and increased independent living. 

A key strength of the model is its collaborative approach. Referrals from health and social care professionals allow the service to reach people who may otherwise not engage with housing support. This helps target those most at risk of poor outcomes. 

From a health and social care equity perspective, the Hub addresses inequities linked to poor housing. People living in inadequate housing are more likely to experience ill health and higher use of emergency services. By improving living conditions, the service reduces some of these avoidable differences. 

The case study also shows that relatively low-cost interventions can have a significant impact. Simple changes such as installing heating, removing hazards or improving accessibility can support people to remain at home and reduce reliance on more intensive services. 

Overall, this example highlights the importance of housing as part of an integrated health and social care system. Without addressing housing conditions, efforts to reduce health inequities are likely to remain limited.