Background
In England, integrated care systems (ICSs) rely heavily on the workforce to deliver coordinated, person-centred support across the health and social care sectors. Yet the workforce faces persistent shortages and inequalities that undermine its capacity and wellbeing, particularly frontline social care workers. Women make up the majority of the care workforce, who often experience poor pay, insecure contracts, and limited career progression. Migrant and minority ethnic women face further challenges, including systemic racism, restricted training opportunities, and lack of recognition of prior qualifications. Therefore, this study explored the training needs and wellbeing of domiciliary care workers, in the social care sector, at the intersection of race, gender and migration. As domiciliary care workers act as a bridge between health and social care by supporting individuals in their homes, this study has implications for how ICSs can strengthen workforce capacity, skills and inclusivity.
Method
A robust qualitative study design was chosen to conduct thirty semi-structured online interviews with participants based in England. The sample included 18 social care workers, comprising migrant women (n=13, minority ethnic) and non-migrant women (n=5, White British), as well as 12 policymakers. Semi-structured interviews allowed for nuanced exploration of the participants unique experiences. An intersectional lens was used to understand the barriers experienced by women in the social care workforce.
Results
Participants reported significant stressors undermining workforce capability and sustainability. Social care workers described physical and emotional exhaustion, compounded by low pay, inadequate leave, and insecure employment. Migrant women reported discrimination, racism, and difficulties having their qualifications recognised, which restricted progression and diminished their sense of capability. Training gaps, for example, rushed onboarding, unpaid shadowing, and inconsistent refresher courses left workers feeling unprepared and undervalued. While training was generally welcomed, financial and logistical challenges limited its effectiveness.
Limitations
The diversity of workforce experiences may not be fully represented, as the study focused primarily on women. The sensitive nature of discussing race and gender may also have constrained some responses. Including men in future research would offer additional insights into gender dynamics and career progression within a female-dominated sector, strengthening understanding of how workforce inequalities affect the delivery of integrated care.
Implications
These findings demonstrate how entrenched inequalities in social care weaken the very workforce upon which integrated care depends. Without inclusive workforce strategies, ICSs risk compromising workforce capacity, skills and long term resilience of the workforce. Integrated care can make a positive contribution by:
• Developing and implementing inclusive workforce strategies that recognise and value diverse skills and lived experiences.
• Collaborating with wider agencies to design equitable and accessible training pathways that build workforce capability.
• Advocating for structural change in contracts, pay, and recognition of qualifications.
• Investing in a diverse workforce to strengthen capacity, skills and inclusivity across systems.
Embedding intersectional perspectives in workforce planning ensures that integrated care not only supports staff wellbeing and retention but also contributes to workforce capacity and capability as well as contribute to reducing inequalities in service delivery and outcomes.

Background:
Creating vertical and horizontal integration across health, social care and welfare services to improve outcomes for people with increasing and complex needs is challenging. Using evidence from elsewhere and turning learning into action often fails because systems are complex, interdependent, and unpredictable. A promising solution is embedding learning directly in real-world contexts through relational researcher-in-residence approaches - enabling improvement, innovation, and impact in real time.

Approach:
This interactive session draws on our experience across diverse public service settings—primary, secondary, mental/public health, children’s and adult social care, and the voluntary sector – we will:
• Introduce the approach: Brief overview of roles and frameworks (embeddedresearch.org.uk).
• Showcase impact: Select case studies from over 15 projects co-produced with service users, communities, and partners across the Southwest Peninsula Integrated Care Systems since 2016.
• Hands-on exercises: Guide participants through practical activities to:
o Map their ambitions for applying this approach in their own settings.
o Identify opportunities and challenges collaboratively
• Breakout discussions: supported by researchers-in-residences, practitioner-/peer-researchers.

Results
The workshop draws on content that relates to all four conference themes around diversity:
1. Community-based care: intermediate care for older people (1,2,3); transitional care for younger people (4).
2. Prevention and technology-enabled care: social prescribing (5,6); asset-based community development (7); peer-based interventions (8); health coaching (9).
3. Health inequalities and wider determinants: Population Health Management, Multiple Disadvantage, Coastal Inequalities (10,11,12).
4. National Institute of Health and Care Research (NIHR) workforce capacity building: peer-/practitioner-research (13,14); Human Learning Systems – appreciative enquiry (15).

Learning outcomes
• Understand what embedded research teams are and their role improving service integration
• Learn how researchers-in-residence work and what skills/support are needed
• Explore methodological, practical, and ethical opportunities and challenges
• Develop strategies for sustainable embedded research
• Build connections for a community of practice (e.g., Special Interest Group)

Implications:
This approach represents a cultural shift away from linear, reductionist, and siloed methods often employed when evaluating and implementing integrated care to an approach that embraces complexity. It enables the development of bespoke, relational services shaped by both data and stories, and supported by system stewardship. Using the researcher-in-residence approach in Integrated Care Systems anchors and pools resources for sustainable academia-practice partnerships combining rigour and relevance, implementation and impact, and supporting continuous learning, rapid evaluation, and improvement.

References:
1. Impact of ‘Enhanced’ Intermediate Care (2022); https://doi.org/10.5334/ijic.5665
2. Integrating the voluntary sector (2022); https://doi.org/10.1108/JICA-02-2020-0010
3. Context in Complex System Change (2020); https://doi.org/10.5334/ijic.5196
4. Multi-Agency Transitions for Young People (2025); https://doi.org/10.5334/ijic.9055
5. Social prescribing ‘holistic’ link-worker (2019); https://doi.org/10.1017/S1463423619000598
6. Impact of COVID-19 on social prescribing (2022); https://doi.org/10.1111/hsc.13802
7. Community Cancer Champions’ Project (2025); https://doi.org/10.5334/ijic.9054
8. Peer coaching for adults with long-term conditions (2024); https://doi.org/10.1136/bmjopen-2024-087020
9. Targeted telephone-based case management (2022); https://doi.org/10.1186/s12913-022-08415-2
10. VCFSE in Early Help (2023); https://doi.org/10.1111/cfs.13034
11. Family support in a seaside resort (2024); https://doi.org/10.1016/j.geoforum.2024.103943
12. Housing and children’s social care (2024); https://doi.org/10.1080/02673037.2024.2419527
13. Reflections on the Researcher-in-Residence model (2019); https://doi.org/10.1332/174426419X15538508969850
14. Ecotherapy Program for Adolescence (2025); https://doi.org/10.3390/ijerph22050720
15. Open appreciative inquiry to generate cultural change (2025); https://doi.org/10.1177/01447394251360762

Background: Integration of patient-oriented research evidence into decision-making around care, policy, and healthcare delivery is the foundation of learning health systems (LHS). Little is known about the nature and scope of training programs that aim to build capacity amongst researchers, trainees, patient partners and others relevant to supporting engagement in learning health systems. This study involved an environmental scan and key informant interviews to gather data regarding current training programs in Ontario and their fit with the various components of a learning health system model.
Approach: We identified, described and reviewed existing training programs in Ontario, and evaluated their alignment with the five ‘learning gears’ or dimensions of a LHS Action Framework (Reid et al, 2024), including: analytics and population insights; evidence synthesis; patient, caregiver, and provider co-design; implementation; and, evaluation, feedback, and adaptation, with equity as a key driver of the system. We conducted a limited review of the existing literature, completed qualitative interviews with leaders and coordinators of the training programs, and reviewed publicly available information (published and grey literature) about the individual training programs. We adopted a systematic approach to the review and mapping of the programs to the LHS model, and applied a framework for describing interventions known as the TIDierR framework involving a 12-item checklist (Hoffmann et al, 2014). The project team included a patient partner, researchers, students and a member of the Ontario SPOR SUPPORT Unit (OSSU).
Results: A range of capacity building initiatives for patient-oriented research have been developed in Ontario, often supported through OSSU funding. Only ten of 74 training programs involved educational activities and topics that were relevant to enabling learning health systems. Only one training program addressed all five of the learning gears in the LHS framework.
Implications: There are challenges with the implementation of learning health systems such as pervasive gaps in the generation and application of evidence relevant to healthcare systems, the role of patient partners, and the lack of relevant training programs. There is a need for investment in practical educational initiatives that engage all key stakeholders (researchers, patient partners, healthcare professionals, trainees and decision makers) to optimize potential improvements in care, policy, and service delivery through the adoption of a learning health system model. Consideration of the attention to training activities that focus on the different components relative to the learning gears of a LHS will help to guide this investment to optimize training and its potential impact with the implementation of learning health system or equivalent models for health system improvement.

Background
Patient and caregiver engagement is central to high-quality integrated care, yet its impact is difficult to capture in real programs. The integrated care program (ICP) we studied supports people for up to 90 days after hospital discharge, linking hospital, primary care, and home and community services through a shared plan and a single point of contact. The program is based at the University Health Network (UHN) in Toronto, Ontario, Canada. The program has grown quickly through collaboration with patients, caregivers, and staff, but there is limited documentation that traces how engagement shaped decisions over time or how participants judge its most meaningful contributions.

Approach
A patient partner (lead author) designed and facilitated a 30-minute “Mapping Meaningful Moments” activity within a Learning Health System workshop that brought together patient and caregiver partners, program leads, clinicians, and researchers at mixed tables. Notes and worksheets were collected, de-identified, and analyzed collaboratively to identify where and how engagement influenced design, implementation, and evaluation. To complement the activity, we invited patient and caregiver partners and program staff and leaders to complete role-tailored question sets from the Public and Patient Engagement Evaluation Tool (PPEET v2.0, Module B). The survey asks participants to rate how well key features of the engagement worked, including clarity of purpose and roles, information and supports, opportunities to share views, and the extent to which input influenced decisions. This provides a shared frame for comparing experiences across roles.

Results
Early analysis shows that engagement influenced both culture and practice. Storytelling with real patient journeys replaced data-heavy slide decks and helped align decisions with patient realities. Co-design produced concrete fixes, such as clarifying discharge roles and arranging essential supplies before patients return home, and journey mapping refined pathways during periods of rapid expansion. Mixed-role discussions helped teams separate cross-program themes from pathway specific issues. PPEET v2.0 Module B responses will be summarized descriptively and integrated with the workshop analysis. Items that explore perceived influence, clarity of purpose and roles, respect for participants’ views, and communication about follow-through will capture aspects of engagement that are hard to observe directly. Open-ended responses will add further context and examples. Together, the survey and workshop findings will show how widely these patterns are shared across roles and suggest practical markers to follow over time, such as the percentage of respondents who felt their input influenced decisions.

Implications
This patient-partner-led, mixed-methods approach helps teams surface and organize participant-reported examples of engagement impact and link them to practical indicators. Pairing collaborative analysis with brief surveys makes both tangible practice changes and subtler shifts in perspective easier to see. The materials we outline can be adapted by others to improve how results are shared back and how future improvements are prioritized.