From trusted intruder to real collaborator: Mapping the ecosystem of stakeholders and community assets in a coastal region in England, with a focus on end-of-life care and bereavement support

Abstract

While policy efforts to promote health through integration across sectors are not new, the 2022 UK Health and Care Act formalised Integrated Care Systems (ICSs) as legal entities with statutory powers in England. This includes a legal responsibility to commission adequate palliative and end-of-life care services, including bereavement support, for the communities they serve. Cross-sector partnerships that leverage community assets are recommended to tackle inequities towards the end of life and in bereavement. However, the nature of effective, equitable partnership remains unclear, and asset-based approaches have been criticised for neglecting issues of power and potentially transferring the responsibility for solving social and health injustices to communities. Aware of these debates, we critically explore the conditions that enable inclusive collaborative relationships and integration across sectors, as well as the barriers that prevent this, within the ecosystem of one coastal region in England. We conducted a system mapping study, drawing on theories of death systems, social capital, and service ecosystems, understood via Service-Dominant Logic (S-D L).Our three-phase participatory, qualitative study involved three community network meetings (attended by 35–55 stakeholders across sectors), a participatory digital mapping workshop (n = 19), and semi-structured interviews analysed using inductive thematic analysis (n = 15 stakeholders across sectors). Digital mapping showed weak or unstable bridging capital between sectors. Interviews highlighted that attending to the relational foundations of integration is essential but often omitted: opportunities and time to understand each other and co-create a shared vision, understanding differences and deepening connections, and, fundamentally, addressing power differentials. Failed attempts at generating bridging capital were linked to extractive relationships, widespread staff shortages and inadequate funding and resources, particularly in the VCSE. Understanding the nature of collaboration and social capital in a locality can support public health approaches which go beyond naïve calls for cross-sector collaboration to engender meaningful change.