Key messages

• pooled budgets support integration but are not sufficient on their own
• past experience of collaboration and strong local leadership are critical enablers of effective integration
• local organisational structures shape how integration is implemented in practice
• uneven motivation and resource availability across localities limit consistent progress
• integration efforts risk reinforcing local funding inequities if contextual differences are not addressed.

Policy implications

• neighbourhood integration strategies should invest in leadership development and relationship-building
• learning from previous collaborative arrangements can support more sustainable integration
• funding and support may need to be tailored to local context rather than applied uniformly
• governance arrangements should account for variation in local capacity and readiness.

Gaps

• limited evidence on long-term outcomes of STP-led integration efforts
• lack of comparative analysis across different integrated care systems
• limited insight into how local inequities affect experiences.

Commentary
This study highlights the complexity of delivering neighbourhood health and care through system-level integration initiatives such as Sustainability and Transformation Partnerships. While pooled budgets are often emphasised as a mechanism for integration, the findings suggest that relational and leadership factors play an equally important role.

Local leadership and prior experience of collaboration shape how integration is interpreted and enacted. From a care equity perspective, this means that neighbourhood health and care is likely to develop unevenly, depending on historical relationships and institutional capacity rather than population need alone.

The study also draws attention to variation in motivation and resources across localities. Where some areas are better equipped to engage with integration agendas, others may struggle to participate fully, risking widening inequities in service development and access.

By focusing on Greater Manchester, the study illustrates how local structures influence integration in practice. It suggests that neighbourhood health and care requires flexible policy approaches that recognise local variation, rather than assuming uniform readiness or capacity.

Overall, the findings underline that equitable neighbourhood health and care depends on more than structural reform. Sustained leadership, contextual sensitivity and targeted support are central to ensuring that integration improves access and outcomes across all localities, not only those with existing advantages.