Key messages

• current integration efforts largely focus on individual-level services rather than multi-level or multi-sector approaches
• there is increasing recognition of the importance of wider determinants of population health in supporting integration
• integration requires time to embed, allowing new structures and relationships to develop
• tensions remain between top-down policy-driven approaches and locally driven models
• evidence of effective multi-level and multi-sector integration for older adults with multimorbidity remains limited.

Policy implications

• neighbourhood integration strategies should move beyond individual care coordination to address broader determinants of health
• policymakers may need to allow longer timeframes for integration initiatives to mature
• whole-system approaches should balance national direction with local flexibility
• evaluation frameworks should capture progress at multiple levels of integration.

Gaps

• limited empirical evidence of sustained multi-level integration in England
• lack of robust evaluation of neighbourhood-based models for people with multimorbidity
• limited insight into how integration affects outcomes and equity for older adults.

Commentary
This study highlights the challenges of delivering neighbourhood health and care for older adults with multimorbidity. Despite policy ambition, integration remains largely focused on individual-level coordination rather than multi-sector approaches that address wider determinants of health.

The findings emphasise the importance of time in enabling integration to take hold. Building relationships, shared understanding and trust across organisations cannot be achieved through short-term initiatives, particularly in neighbourhood settings where collaboration spans health, social care and community services.

The tension between top-down and bottom-up approaches is a recurring theme. While system-level structures are necessary to support integration, local flexibility is essential to respond to neighbourhood context and population need. From an equity perspective, overly standardised models risk failing to address local variation.

Overall, the study suggests that neighbourhood health and care for people with multimorbidity requires whole-system thinking that extends beyond service coordination. Without sustained investment, time and multi-sector engagement, integration is unlikely to deliver equitable improvements in access or outcomes for older adults with complex needs.