Summary
- An Integrated Care Board in England partnered with IHI to improve population health and equity. The work built lasting collaboration between residents, clinicians, and community partners, while strengthening improvement capability for sustained change.
The Bedfordshire, Luton and Milton Keynes (BLMK) Integrated Care System serves nearly one million people across a diverse and growing region in England. The area includes vibrant, multicultural towns alongside more rural communities, with clear differences in health outcomes and levels of deprivation. Like many systems across England, BLMK is working to improve health while tackling these inequalities head-on.
Established in 2022, the Bedfordshire, Luton and Milton Keynes Integrated Care Board (ICB) is responsible for planning and funding NHS services locally. But it quickly became clear that improving outcomes would require more than better coordination of services. Insights from the Denny Review highlighted a deeper challenge: the need to rebuild trust with residents and design care around what truly matters to communities.
With the need for change clear, the ICB partnered with the IHI to advance a large-scale improvement effort focused on health, well-being, and equity. The ambition was simple but significant — bring together partners from across the system, including communities themselves, to test new ways of working and drive meaningful change.
The Approach: Building the Foundations for Change
The work began with a deliberate first phase focused on understanding before acting. Rather than launching straight into solutions, the ICB and partners took time to build a shared understanding of how the system was working — and where it was falling short.
This discovery phase combined data analysis with conversations across the system, including with people with lived experience. It asked some fundamental questions: Who isn’t thriving? Where are outcomes unequal? And what would it take to change that? By looking at both the data and real experiences of communities, the system was able to identify priority areas and better understand the root causes of poor outcomes and inequities. Through this process, unmanaged hypertension emerged as a priority focus for improvement across several communities.
Just as importantly, this phase explored the strengths already in the system — existing services, partnerships, and community assets — alongside gaps and barriers. This helped shift the mindset from isolated efforts to a more coordinated, system-wide approach.
Designing a Collaborative, Community-Centered Model
Insights from this discovery work were used to co-design a Learning and Action Network (LAN), which is a structured way of bringing people together across organizations and communities to improve outcomes. Residents and community partners were at the center of the LAN, ensuring that improvement efforts were shaped by those most affected.
During the discovery phase the ICB and partners established shared goals, a clear governance structure, a measurement and learning system, and a plan for engaging teams across the system. These were crucial foundations for success.
From Planning to Action: Testing and Learning Together
With these foundations in place, the program progressed through the Learning and Action Network, which combined regular learning sessions with action periods. Learning sessions created space for teams to build skills, share experiences, and plan their work. Between these sessions, teams tested changes in real-world settings — trying new approaches, learning quickly, and adapting based on what worked.
This cycle of learning and testing helped teams move beyond ideas into practical change. It also created a shared way of working across the system, with a strong focus on equity, partnership, and continuous improvement.
Why This Approach Matters
At its core, this wasn’t just a program — it was a different way of working.
By starting with listening and understanding, engaging with communities as partners, and supporting teams to test and learn together, the ICB began to rebuild trust with residents and create the conditions for more sustainable improvement in population health.
Every team worked directly with residents — not just as participants, but as partners. In the words of one resident, “Health outcomes improve when people understand, feel heard, and are genuinely involved — not just treated.”
Key to this approach was integrating learning with action. Teams built improvement capability while testing changes in real-world settings, and coaches and leaders developed skills alongside frontline teams. This helped embed a shared way of working across the system, grounded in equity, partnership, and continuous improvement.
What Changed, and What Made It Possible
Despite significant system disruption during this three-year program — including an ICB merger and workforce reductions — there is clear, measurable progress.
In one general practitioner (GP) practice, blood pressure control improved from 26 percent to 42 percent, alongside increased patient engagement with check-ups. Across the program, teams strengthened key processes such as screening, follow-up, and treatment planning. All teams involved residents in co-design, and many reported stronger cross-sector collaboration.
System-level progress is also emerging. When this work began, BLMK ICB ranked lowest among ICBs in England for hypertension management. As of March 2025, it has moved to third from the bottom, improving faster than many peers and beginning to close the gap.
These results reflect more than individual interventions— they signal a shift in how the system works. Teams partnered with residents to shape solutions grounded in lived experience, helping rebuild trust and improve engagement. The Learning and Action Network enabled a shared approach across organizations, supporting teams to test changes, learn quickly, and adapt in real time. At the same time, teams strengthened their use of data to guide decisions and refine their work.
Together, these shifts are building a stronger foundation for sustained improvement, with teams continuing to test, adapt, and tailor approaches to different populations.
Final Reflections
Like many complex efforts, this program faced real constraints, uneven progress, and significant disruption. But it demonstrated something important: even complex systems can begin to improve when they invest in capability, build genuine partnerships with communities, and create the discipline to learn and adapt over time.
As Integrated Care Systems seek to improve population health and reduce inequities, approaches like this can help turn that vision into everyday practice.
Lourena Mendes, MPH, is a Program Manager at IHI. Brenda Carson, RN, is an IHI Improvement Advisor. Susan Hannah, RN, is a Senior Director at IHI.
Photo by Gary Butterfield on Unsplash
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