Care Boards (ICBs) and Integrated Care Partnerships (ICPs) have been established across England’s 42 system areas.

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The aim of this reform is to build a more connected, patient-centred health and care system — one that delivers timely, coordinated and efficient care across sectors. It builds on the NHS Long Term Plan’s ambition to tackle health inequality, put citizens at the centre, and shift services upstream to focus on prevention.

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This policy direction speaks strongly to the voluntary, community and social enterprise (VCSE) sector, which has long played a vital role in improving health and wellbeing.

A new role for the VCSE sector

The ICS Design Framework (NHS England, June 2021) sets out an enhanced role for the VCSE sector — not just as service providers but as partners in system leadership and governance.

It recommends that ICS leaders:

• Value the sector’s knowledge and expertise and invest in grassroots organisations.

• Focus on local VCSEs, not only larger providers.

• Recognise the substantial resource needed to engage strategically with new structures.

• Put in place formal agreements for engaging and embedding the VCSE sector in governance.

• Use VCSE alliances to strengthen coordination across the system.

• Link place-based and neighbourhood work into wider ICS structures.

• Take a coordinated approach to social prescribing and multi-disciplinary working.

• Continue involving the VCSE sector in provider collaboratives, recognising the innovation it brings.

A huge opportunity — and real challenges

For many, this may look like yet another restructuring. But this time, the level of attention given to the VCSE sector is significant, supported by national funding programmes to build sector capacity.

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The challenge lies in the sector’s structure itself. Unlike the NHS provider sector — typically a handful of large foundation trusts — the VCSE sector is made up of thousands of organisations, from small community groups to household-name charities.

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This diversity is a strength, enabling agility and reach into marginalised communities. But from the outside, the sector can appear fragmented and difficult to navigate.

Building VCSE Alliances

To address this, the VCSE sector in every ICS area is being supported to develop a VCSE Alliance that can:

• Provide a unified voice for the sector

• Manage competing interests

• Act as a front door for external stakeholders

• Amplify the voices of the most vulnerable

• Coordinate strategy and strengthen relationships with government, business and funders
   

However, many VCSE sectors have not previously operated at ICS-level geography, meaning new relationships, governance structures and collaborative models are still being built.

What makes collaboration work

Past experience shows that picking a model isn’t enough. The success of VCSE involvement in system transformation depends on investing time in:

• Building sustainable relationships

• Creating a shared vision and values

• Developing clear principles of joint working, captured in formal agreements

• Securing investment and resources

• Strong leadership at system and place levels
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Without these foundations, engagement risks being tokenistic. With them, the VCSE can help shape genuinely integrated health and care systems.

Leadership and representation

A key challenge is resourcing leadership and representation. Effective VCSE participation requires time, investment and support — particularly for small organisations.

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In a recent Shared Purpose deep dive, our team mapped existing VCSE structures in one ICS area. We saw:

• Strong examples of leadership, such as a pilot mentoring programme for leaders of small BAME-led organisations, with funding to backfill time for strategic roles.

• Significant disparities in investment, especially for local infrastructure functions.

• Persistent challenges for smaller organisations struggling to have their voice heard.
   

Our recommendations aim to help build stronger, more inclusive VCSE alliances that can shape system-wide change