Key points
Healthcare leaders are concerned about the impact of increasing rates of child poverty on local communities, patients and staff. There is an opportunity for integrated care systems (ICSs) to play a critical role in the delivery of the government’s child poverty strategy in relation to its third objective, which is to alleviate the impacts of child poverty.
In many parts of the country, ICSs are using a number of levers to do this, including integrated care strategies, integrated care partnerships, health and wellbeing boards, tackling health and care inequalities through CORE20PLUS5; acting as anchor institutions and anchor systems; working through place, and working through integrated neighbourhood teams.
The common thread running through examples where this work is being delivered particularly well is responsiveness to local need, genuine engagement with communities, partnering with existing and trusted organisations embedded within communities and investing in the development of those relationships.
The government’s child poverty strategy should seek to use and strengthen the existing levers through which ICSs are delivering services and programmes that alleviate the impact of child poverty. Trying to create new architecture or mechanisms to deliver this would be a waste of time and resource, particularly in the current economic climate.
It should also use the child poverty strategy to strengthen these levers to ensure ICSs are empowered to deliver this work. Doing this would also deliver a number of wider benefits to the functioning of the health and care system, including supporting delivery of the government’s three shifts for the NHS, building a more sustainable future and mirroring the government’s national health mission in local communities.
The question for the government is whether its strategy is to be an enabler and accelerator to this work or to make this work harder by introducing new approaches.
Background
Since 2010, child poverty has increased by over 700,000 and over 4.3 million children now live in poverty in the UK. The link between young people’s socio-economic backgrounds and their life chances holds millions of children back.
The child poverty strategy is the government’s national plan to reverse the trend and bring about an enduring reduction in poverty. It’s a key plank of its Opportunity Mission, which seeks to break the link between a child’s background and their future success.
The government has said the strategy will tackle the systemic drivers of poverty by:
- increasing incomes: examining how the government and business can work together to support parents into secure employment – this will include childcare to enable parental employment
- reducing essential costs: working with business to tackle key cost drivers for low-income families and looking at where these costs are a barrier to education and employment
- increasing financial resilience: working with different stakeholders, from financial institutions to charities, to find solutions to debt and enable families to build savings – this can reduce the risk of future generations slipping into poverty
- better local support, focused on early years: working with community, local and national partners to improve access and quality of services for children of all ages.
The government will publish both a short and long-term plan for action, looking ahead to the mid-2030s. This is due to be published in spring. At the end of 2024 and early 2025, the Child Poverty Taskforce met with experts on each of the strategy’s themes, including experts on children’s health. The NHS Confederation took part in one of these taskforce meetings in January 2025.
Poverty is a key social determinant of health. Children living in poverty are at greater risk of poor physical and mental health outcomes. There has been a twofold increase in the proportion of young people aged 17-22 with a probable mental health disorder who said that they could not afford to buy food or had used food banks.
Poor housing conditions also contribute to physical and mental health issues. Children growing up in cold, damp homes are more than twice as likely to suffer from respiratory conditions than their classmates in warm homes. Child poverty is linked to a wide range of poorer health outcomes, including low birth weight, poor physical health, mental health problems, experience of stigma, academic underachievement, subsequent employment difficulties and social deprivation.
About this briefing
In October 2024, the Child Poverty Strategy Unit at the Department for Work and Pensions contacted the NHS Confederation seeking reflections from ICS leaders on their role in alleviating the impact on child poverty. This is the third objective of the government’s child poverty strategy.
In response, we brought together a virtual roundtable of integrated care board (ICB) and integrated care partnership (ICP) leaders, where they shared work on this objective being delivered in their local system, highlighted the system levers available to deliver this work and proposed ways these levers could be strengthened by government.
This briefing summarises that discussion and highlights the key calls to government to ensure the role of systems is used to their full potential as part of the child poverty strategy. A version was also shared with the Child Poverty Unit for consideration as part of the strategy development process.
System-level levers to address the impact of child poverty
Healthcare leaders are concerned about the impact of increasing rates of child poverty on local communities, patients and staff. In a roundtable we held with ICS leaders in October 2024 on child poverty, attendees shared concern about long-term health inequalities and increasing demand on already stretched NHS services. They also emphasised the importance of keeping children at the forefront of service leaders’ agendas for the strategy when also battling pressures such as urgent and emergency care and primary care access. A number of attendees shared that they would value a national evidence repository of ‘what works’ approaches, based on case studies.
Only 20 per cent of health is determined by healthcare, with the remaining 80 per cent affected by wider determinants. Therefore, improving the health of the nation needs a cross-government approach which goes far beyond just the NHS. This is critical for making a more sustainable future for the NHS and is an argument the NHS Confederation has been making for some time.
Integrated care systems (ICSs) have a critical role to play in the government’s child poverty strategy. In particular, the work of integrated care partnerships (ICPs) in facilitating cross-agency working responsive to community need is a huge opportunity. In many places across England systems are already working to tackle child poverty, using the following levers:
- ICPs
- integrated care strategies
- health and wellbeing boards
- tackling health inequalities through CORE20PLUS5
- acting as anchor institutions
- working through place with communities
- working through integrated neighbourhood teams (INTs).
Integrated care partnerships
Integrated care partnerships – the statutory committee established as part of an ICS – are central to the delivery of integrated care strategies, bringing together the groups that have a role in improving local health, care and wellbeing. This covers local authorities in the footprint; representatives from the integrated care board; representatives of the voluntary, community and social enterprise (VCSE) sector; and, in many areas, also involved public health; social care providers; housing organisations; police and crime commissioners; local businesses and others.
Each ICP must develop a long-term strategy to improve health and social care services and people’s health and wellbeing in the area. The quality of relationships between partners is central to this endeavour.
"I am proud to see our system strategy prioritising the best start in life for all children. Our locally developed poverty strategy, created in collaboration with our dedicated partners, emphasises a strong commitment to addressing child poverty. This partnership approach ensures that we leverage the strengths and resources of each organisation involved, creating a more comprehensive and effective strategy.
“Our collective efforts are also reflected in the distribution of the Household Support Fund, where we place a particular focus on supporting children and families. By working together, we can ensure that every child receives the support they need to thrive, demonstrating the power of collaboration in achieving our shared goals. Successful collaboration is already underway, showcasing the positive impact we can achieve when we unite our efforts and work towards a common purpose." ICP Chair, East Midlands
Case study: Cornwall and Isles of Scilly ICP
Partners across the ICP are supporting the delivery of drop-in clinic mental health hubs in five further education colleges, with a further seven drop-in community sessions in the late afternoon in areas of social deprivation. They are staffed by youth workers and mental health wellbeing workers (CYP IAPT trained). They take a holistic approach to mental health, seen in the context of lived experience and other social and educational pressures.
They have worked with young people to support them with a range of issues relating to poverty, including signposting and advocating for young people, to housing support and Citizens Advice, providing food vouchers and working with specialists partners including LGBT support services to provide bespoke support.
Many ICPs also work closely with combined authorities, with Greater Manchester ICP and South Yorkshire ICP both being chaired by their respective metro mayors. This includes working to tackle child poverty in England’s regions.
Case study: North East and North Cumbria ICS
North East and North Cumbria ICS is one of a wide range of partners to make a shared regionwide anti-poverty commitment, alongside the North East Mayor Kim McGuiness and the combined authority.
More than 350 people from businesses, housing, charities, social enterprises and the public sector came together at the North East Child Poverty Summit in November 2024, expressing strong support for a shared mission to tackle child poverty. This will now be taken forward across four main areas: maximising family incomes now, making work a route out of poverty, securing a regionwide anti-poverty commitment and ensuring best start in life through more healthcare support in schools and more.
At the summit, the mayor announced a £55 million package of measures to tackle the high levels of child poverty in the north east.
The role of local authorities and combined authorities in ICPs means they are increasingly a mechanism by which much preventative work is undertaken. In a report we published in October 2024, we undertook an analysis into the economic return on investment on a number of preventive health interventions.
One particular area of note was the impact of intervention on children and young people, including those related to education. When considering return on investment (ROI) by age, there was no variance by age for interventions, with many studies not considering the impact of the intervention beyond more than five years of age. The implication of this is that investment in children and young people returns at least as much as older people and is likely to exceed the stated ROI, given the lasting effects of childhood health on adult health, employment and socioeconomic status.
Case study: South Yorkshire
As chair of the local integrated care partnership, South Yorkshire Mayor Oliver Coppard has introduced and funded a Beds for Babies: Safe Place to Sleep programme. One-in-nine newborns in Sheffield require a safe place to sleep each year, which the programme seeks to address.
The mayor has pledged £2.2 million of funding over four years for the programme.
Working with local councils, NHS services, directors of public health, business, education institutions and national charities, the programme uses existing referral and delivery routes including GPs, family hubs and the wider VCSE sector to tackle bed poverty.
The breadth of membership of integrated care partnerships in particular – across local authorities, the NHS, the VCSE sector and beyond – means they have a deep understanding of the assets available within local communities, the networks that can be used in pursuit of a common goal, and the needs that must be met to alleviate the impacts of poverty.
“Our partners from the VCSE sector say that, at the ICP, they feel like genuine, equal partners. This has come about through relationship building, listening to VCSE leaders about their priorities, and creating agendas which give a voice to VCSE leaders and providers. This is crucial to our development and ways of working.” ICP Leader, South East
Integrated care strategies
Integrated care strategies were designed to support integration to meet local healthcare, social care and public health needs. In legislation, the Health and Care Act 2022 sets out that integrated care strategies must undertake a number of duties, and suggests areas for focus could include a number of things that relate to addressing the impact of child poverty:
- Disparities in health and wellbeing.
- Population health and prevention health protection.
- Babies, children and young people.
Integrated care strategies are compelled to involve the following groups in their production:
- People and communities, including children, young people and their families.
- Health and social care provider, including adult social care and primary care, local authority and ICB leadership, including health and wellbeing board chairs and district councils.
- VCSE groups.
- Local Healthwatch organisations.
- Wider organisations and partnerships, such as housing, employment, community safety.
Particularly in the face of the cost-of-living crisis over the previous few years, a number of systems have focused on alleviating the impacts of poverty explicitly in their strategies.
Case study: Nottingham and Nottinghamshire ICS
In its integrated care strategy, Nottingham and Nottinghamshire ICS has prioritised adding social value to the local area. It has committed to partnership working with all major suppliers to identify opportunities for local apprentice schemes. This includes supporting disadvantaged groups, putting actions in place to support local people with the rising cost of living, signposting to relevant support services and fair reimbursement for skills, and working directly with young people, looked after children, care leavers, carers, and people with special educational and disabilities, to consider working in health and care.
Through this system-wide approach, the ICS is supporting the most vulnerable households to alleviate the impacts of poverty. It is ensuring that NHS providers and local authority teams in the ICS make every contact count by enquiring about access to food and heating, and through their place-based partnerships supporting access to warm hubs and other support offers through partnerships with the VCSE sector.
Health and wellbeing boards
First introduced by the 2012 Health and Care Act, health and wellbeing boards (HWBs) continue to exist in the new architecture brought in by the Health and Care Act 2022. As a formal committee of the local authority in partnership with other services, they set the strategic direction to improve health and wellbeing in a particular place.
When ICSs were introduced as statutory bodies in July 2022, the Department of Health and Social Care (DHSC) set out that all place-based arrangements were expected to build on and work with existing forums such as HWBs as key existing place-based forums for driving integration.
HWBs have a statutory duty to produce a joint strategic needs assessment (JSNA) and a joint local health and wellbeing strategy (JLHSW) for their local population that sets out priorities for improving health and wellbeing. As part of this strategy, partners will be given joint priorities and actions to do this.
In our roundtable with ICS leaders held in October 2024, a number cited the enduring critical role of HWBs and cited them as a key lever for alleviating the impact of child poverty.
Case study: Lincolnshire ICS
In Lincolnshire, partners worked intentionally to avoid duplication between the HWB and the ICP when the latter came in to being. They did this by aligning location and frequency of meetings, mirroring membership of the committees and having the executive councillor from Lincolnshire County Council as a representative on the ICP to ensure the aligning of plans and building on strategies where possible, such as the joint local health and wellbeing strategy.
Lincolnshire’s ICS set out the scope and responsibilities for both the HWB and ICP, clearly outlining the expectations of each committee, including what responsibilities they have (and do not have), and where these conversations should take place. Their aim was to demonstrate the importance of collaboration and partnership working rather than operating in silos as the NHS and local government.
Lincolnshire’s ICS built the foundations for effective partnership working, resulting in collective action in the preparation of strategies both at system and place level, and a unified response to deliver for its local communities.
Tackling health inequalities – CORE20PLUS5
With tackling health inequalities as one of their four core purposes, ICSs across England undertake a range of activity that focuses on reducing these. A national NHS England programme delivered largely through ICSs, CORE20PLUS5, targets action towards the most deprived 20 per cent of the population as defined by the index of multiple deprivation (the Core20) and other marginalised groups in local areas.
These are defined by ICBs but cover groups including ethnic minority communities, inclusion health groups, people with learning disability and autism and coastal communities, among others (this is the ‘Plus’.) The ‘5’ refers to five clinical areas of focus of the programme: asthma, diabetes, epilepsy, oral health and mental health. Governance for these areas sits with national teams in NHS England. There is clear evidence of links between asthma, diabetes, oral health and mental health problems in children and young people and their socioeconomic background.
While the general view among ICS leaders is that the CORE20PLUS5 framework is helpful, there is also acknowledgement that this is clinically focused framework that does not include the wider social determinants of health in its scope.
Case study: Cheshire and Merseyside ICS
In Cheshire and Merseyside, Champs Public Health Collaborative, made up of the sub-region’s directors of public health and population health, have founded All Together Fairer, a collaborative approach to improving health equity through the social determinants of health.
A number of schemes run under the All Together Fairer banner, including one focused on child and family poverty.
Working with political and professional leadership across Cheshire and Merseyside, the collaborative published a joint statement in September 2024 calling for urgent, coordinated action to ensure that partners work together to meet a shared ambition of no child in Cheshire and Merseyside is living in poverty. The joint statement included reference to a joint action framework for local services and groups to adopt to move towards that shared ambition. The framework has four main pillars: system leadership and advocacy; maximising household income; supporting children and young people and families; and building inclusive places.
The convening role of the ICS was critical in this endeavour, with Professor Ian Ashworth, director of population health at NHS Cheshire and Merseyside, and a member of the ICP, and himself a former chair of Champs Collaborative, central to the project.
The Child and Family Poverty Programme is being taken forward with a broad coalition of support within the context of Cheshire and Merseyside's work on the social determinants of health.
Acting as anchor institutions
Partners in health and care systems have important roles as anchor organisations, or ‘anchor systems’, to support parents and young people into secure, fulfilling employment that drives the social and economic development of local areas. Contributing to wider social and economic development is also one of the four core purposes of ICSs. One example of how they may do this is using derelict premises on high streets to run walk-in health services to both regenerate the local area and make services such as health checks more accessible.
Young people who grow up in poverty typically have lower educational attainment than those who don’t, and this contributes to limited job prospects after school. One way local NHS services can and do help with this is by working closely with local colleges and other education providers to undertake widening participation – offering support, roadshows and other engagement to children and young people to help them work towards employment in the local NHS. Typically, these roles are secure and better paid than other roles available to students with limited academic qualifications.
Through the current WorkWell programme, ICSs are working in partnership with local job centres to supporting adults who have been out of the workforce due to long-term illness and health problems back into work. Ensuring people have the right support in place can often be the difference between them being able to participate in the job market or not. Having parents supported into work can help alleviate the impact of poverty on children and young people, as it often drives up household income and can contribute to improvements in parents’ mental and physical health.
Case study: North Central London ICS
Care leavers often face significant hurdles in accessing education and employment opportunities and are more likely to experience impacts of poverty such as homelessness, as well as facing poorer health outcomes compared to their peers.
North Central London ICB (NCL ICB) has undertaken a Care Leavers Vanguard Programme in collaboration with Middlesex University clinical skills and simulation department, as a pathfinder of NHS England’s Universal Family Programme. The programme offered care leavers an insight into different opportunities to health and care settings, training and development.
The programme looked to increase educational engagement and enhance employability through tailored support programmes, CV support and the opportunity to meet different health and care professionals, and to accommodate various educational needs. NCL ICB has committed to the continuation and support of the Care Leavers Programme going forward.
Working through place with communities
Prioritising community-centred design and delivery of services is key to ensuring ICSs can alleviate the impact of child poverty.
Achieving this demands a strong central vision and mission-driven approach, while empowering local leaders to collaborate, innovate and improve.
Working at place – the geographical level below an ICS covering a smaller population – is critical to counteracting the risk of detachment from local needs due to the larger scale of an ICS where socio-economic status can vary across the footprint. This is particularly true when looking at targeting specific population cohorts. Organisations working at place, such as charities and other VCFSE organisations, often know their communities better and can help ensure programmes and interventions are designed and delivered most effectively.
Case study: Lancashire and South Cumbria ICS
In South Cumbria, two Poverty Truth Commissions have been established in areas facing significant deprivation, with the goal of understanding and addressing the needs and aspirations of residents living in poverty. The task of these commissions is to foster dialogue between those in positions of power and individuals with lived experience of poverty. Over a six-week period, four working groups brought together key figures from the police force, mental health trusts and local councils.
By directly engaging with the community, the commissions aim to develop interventions informed by those most affected by economic hardship. Their mission is to ensure that the voices of individuals with lived experience of poverty are consistently included in policymaking processes, making it a routine practice for these voices to be heard.
While some poverty alleviation work is project based in place-based footprints, in other ICS, the focus has been on system-wide programmes with the focus of delivery being at the place level, so that it can be tweaked to reflect differences and to ensure delivery through existing, trusted organisations.
Case study: North East and North Cumbria ICS
North East and North Cumbria’s Poverty Proofing programme aims to remove or alleviate the impact of the socio-emotional and financial barriers that people in poverty face when accessing healthcare.
The programme is currently reviewing several pathways and services to see how the impact of poverty can be mitigated at an individual and service level, developing a toolkit to support services and organisations to mitigate the impact of poverty and developing a programme of ‘poverty-proofing’ studies.
Children North East, a regional charity, has already worked with health and care services for 0-to-19-year-olds in Newcastle to support them to poverty proof their services through an audit and training programme, which helped their staff to identify the barriers some young people face when using their services.
Working through integrated neighbourhood teams (INTs)
A unit down from place, neighbourhoods, while varying in size, are areas of 50,000 people or fewer. People tend to define their own neighbourhood in ways that reflect the local geography and history where they live. This can differ from how public services define neighbourhoods, who tend to use statutory boundaries like primary care network (PCN) areas or district council boundaries to define them. In many of the most deprived areas these areas become ever smaller and evidence shows some neighbourhoods can be as small as a few streets.
The NHS Confederation recommends that the critical focus for statutory services is ‘thinking neighbourhood’ in all they do, including in taking time to understand the local population, to engage them in developing insight and data, and in leading on local change.
‘Thinking neighbourhood’ is particularly important when approaching poverty alleviation because of the stigma that accompanies living in poverty. Local organisations, staffed by local volunteers and people that reflect communities, are much more likely to be able to undertake effective work on this issue that statutory services. The most impactful INTs create an environment where frontline workers have the autonomy and trust to work with people, including children and their carers, through a holistic and psycho-social model. Citizens are part of the conversations about how services can wrap around their needs and the team of support reaches beyond public sector workers and brings in voluntary, community, faith and social enterprise (VCFSE) expertise.
Case study: West End Morecambe Big Local
In a neighbourhood area where 33 per cent of children are living in poverty, West End Morecambe Big Local has set up a youth advisory group of 45 members aged 12 to 18, to be supported to administer mental health funding for services.
Additionally, projects including social prescribing, a food club and tackling digital exclusion are delivered through partnerships of local organisations, with many delivered through a local community centre that has been present in the local area for many years, which was acquired using Big Local funding on behalf of the community. Critically, many of the projects are resident-led, which increases trust in services.
Through tracking health metrics and seeking regular community feedback, West End Morecambe Big Local has been able to evidence building social capital and improving health outcomes in the local community, as well as alleviating the impacts of poverty.
Strengthening system-level levers to address the impact of child poverty
As set out above, a number of helpful levers already exist and are being actively used to alleviate the impact of poverty and make a tangible difference to the lives of children living in poverty.
The child poverty strategy should seek to use and build on this and strengthen systems’ ability to use these levers successfully. There are a number of policy changes that could help to further enhance the effectiveness of these levers, as set out below. We have been raising these policy asks for some time and in many cases would have multiple benefits, empowering ICS leaders to build a stronger and more sustainable NHS fit for the future, in line with the government’s three shifts for the health service.
Improving data sharing
The inability to effectively share data across systems is a frustration raised time and again by ICS leaders. It is particularly important in relation to the topic of child poverty. Alleviating it is dependent on the ability for a wide range of services – health, education, welfare, children’s social care and beyond – to share data about children and young people to identify those at risk and respond to their need.
We are calling for the following to ensure improved data sharing across systems:
- Greater autonomy for ICBs to support the strong desire for collaborative procurement that would reduce the cost of upgrading data platforms.
- Increased capital spending for infrastructure, including data systems.
We recently published a report that sets out a number of options for the Treasury to use to raise capital investment, in addition to a report that sets out how capital funding processes could be changed to ensure it is allocated more efficiently and used more effectively.
Funding cycles
We need to see longer-term funding cycles coordinated across DHSC, the Department of Work and Pensions, the Ministry of Housing, Communities and Local Government and the Treasury. This would enable systems to better plan for the delivery of integrated services that are set up to respond to the impacts of poverty. As part of this, general allocations with limited ring-fencing would support ICS leaders to design and deliver services to meet local need. Additionally, reforming payment mechanisms would drive integration and shift towards a preventative, upstream focus of investment.
We are calling for the following to ensure ICSs are able to spend money as effectively as possible:
- Use the Spending Review to fund allocations across government departments to align cycles over multiple years.
Outcome-focused targets
Currently in the NHS, ICSs are held to activity targets that focus on waiting times and acute settings. While it of course right that delivering to these priorities is measured to ensure taxpayer money is being spent effectively, it undermines ICSs’ ability to focus on what happens in other settings and in relation to reducing health inequalities and improving population health outcomes, which are both inherently linked to alleviating child poverty.
The overall reduction in targets announced in the 2025/2026 planning guidance was welcomed by ICS leaders, and they recognised that it is right for the current circumstances the NHS faces in relation to waiting lists and government’s stated priorities to take precedence, so long as it is met by reform to deliver the strategic shifts needed.
We are calling for the following to ensure ICSs are incentivised to act on population health, prevention and to shift more care closer to home:
- A better balance between current activity-focused targets with more outcome-focused measures to incentivise them to work towards longer-term goals including prevention and reducing, rather than being beholden to focus on activity measures.
Defining prevention
The 2023 Hewitt review made recommendations to support a shift of resource towards prevention, to define and identify preventive services and to incentivise local and national prevention efforts including through payment mechanisms. The government’s upcoming ten-year health plan provides an opportunity to deliver such changes.
We are calling for the following to ensure ICSs are incentivised to shift their focus from treating disease to prevention:
- Accelerate work on a national framework for measuring prevention spending, including an agreed definition and metric for preventative services (both NHS and local government spending) so a ‘left shift’ can be measured at national and local levels. This work should be broken into phases, starting with agreeing a workable definition that can be iterated, to allow ICSs to baseline consistently. This work should be supported by Cabinet Office and HM Treasury and include such targets in spending and public services agreements. This measure should inform delivery of the forthcoming ten-year health plan.
National ICP forum
As recommended by Rt Hon Patricia Hewitt in her 2023 review of ICSs, a national forum for ICPs, chaired by a minister or co-chaired by ministers, would drive cross-government working and ensure that national government is well connected to local system leaders. This would ensure that the wider policy context could support integrated, cross-agency working in system footprints across services that work on alleviating child poverty. We have been running a shadow ICP forum with the Local Government Association since 2023.
We are calling for the following to support the work of ICPs:
- A National ICP Forum with a ministerial or co-ministerial chair, to ensure local partnerships are supported to take the government’s mission approach to delivery.
Conclusion
The child poverty strategy is a clear example of the Prime Minister’s mission approach to governing. While the government talks about its mission approach as a national endeavour (something we have been pressing for some time), part of this needs to be about equipping local services and agencies to take their own cross-sector approach to tackling local challenges.
The government should consider ICPs as the local version of the government’s mission delivery board for health. The wider ICS must be empowered to further support the work of the ICP through the policy asks detailed in this briefing.
Work across the NHS to alleviate child poverty is in train, and in many places is making a meaningful difference to the lives of children living in poverty. The question for the government is whether its strategy is to be an enabler and accelerator to this work or to make this work harder by introducing new approaches.
