Collaborative action on inclusion health within integrated care systems

Key messages 

• Inclusion health groups are populations who experience extreme social exclusion and very poor health outcomes, often due to overlapping disadvantages such as poverty, stigma, unstable housing, trauma, and barriers to accessing services. The term is widely used in UK health policy and research. 

• inclusion health groups experience some of the most severe health inequities in the UK, with life expectancy estimated to be around 20 years lower than the general population 

• people within inclusion health groups often experience overlapping forms of exclusion including homelessness, poverty, stigma, trauma and discrimination 

• integrated and collaborative approaches across health, social care and community organisations are required to address these complex needs 

• the report identifies promising practice areas including co-production with people with lived experience, strategic leadership for inclusion health, prevention-focused approaches, improved safeguarding and workforce development 

• neighbourhood and integrated care models can support inclusion health when services are coordinated and shaped around local needs 

• fragmented services and lack of coordination across organisations remain major barriers to improving outcomes for excluded populations 

Policy implications 

• integrated care systems should embed inclusion health priorities within system planning and commissioning 

• services for inclusion health groups should be co-designed with people who have lived experience of exclusion 

• stronger cross-sector collaboration between NHS services, local authorities, housing providers and voluntary organisations is required 

• improved data collection and evaluation are needed to understand local needs and measure progress 

• workforce development and training may help staff better respond to the needs of people experiencing severe exclusion 

Gaps 

• the report highlights variation in how inclusion health approaches are implemented across integrated care systems 

• limited consistent evaluation of inclusion health initiatives makes it difficult to compare outcomes between local areas 

• data on inclusion health populations remain incomplete in many health systems 

• further research is needed to understand which integrated models are most effective for different inclusion health groups 

Commentary 
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.