56 Suffolk and North East Essex ICS | ‘Our Journey Together’ some early signs of such dynamics, such as the way trust, quality of relationships and the inclusion of marginalised voices are starting to reinforce each other. True regenerative dynamics would also spiral up wider ecological health and human health in mutually reinforcing ways, as emphasised in frameworks such as One Healthxlviii (World Health Organization 2026). Philosophically, this requires working as if humans and nature are inextricably connected and interdependent. This perspective is rare in Western health systems but is increasingly recognised as important (e.g. due to health benefits from ecosystem services). Nonetheless, the care that Suffolk and North East Essex ICS has applied to its relationship-building is a powerful foundation from which wider regenerative dynamics could be built. As a whole, when we examine Suffolk and North East Essex ICS we see an unusually sophisticated ecosystem of actors with considerable potential to develop as a transitional system for health system transformation. The ICS stands out in the wider UK context in how it has started to treat itself as a living system and its focus on the quality of its interpersonal relationships. Those involved in the partnership seem to be working more fluidly across boundaries which in turn is enhancing collaboration, innovation and unlocking potential. In short, its approach can be summarised as establishing a new way of being that goes beyond just operating as a coordinated network. Suffolk and North East Essex ICS is now in a good position to provide the support for deeper systemic change to occur. There are five clear lessons for the establishment of future partnerships that emerge from these reflections on Suffolk and North East Essex ICS work on supporting system transitions: 1. Treat partnership as a living system, not an organisational hierarchy. Prioritise the quality of relationships between partners over formal structures. Fluid, relational ways of working, not top-down management, were central to Suffolk and North East Essex ICS’ effectiveness as a transitional system. 2. Build in deep reflexivity from the start. Go beyond performance monitoring to embed reflexivity that challenges underlying assumptions. 3. Actively redistribute power and amplify marginalised voices. Genuine system change requires more than consultation – it means embedding community voice into decision-making, as Suffolk and North East Essex ICS did through initiatives like Maternity Equalities and the Fella Forum. 4. Protect transformational intent against tendencies towards innovating to sustain a status quo. Without explicit commitment to fundamental change, regular checks against drift, and embedding transformation-focused evaluationxlix (Buckton et al. 2025) across operations, resource pressures and short-term targets will almost inevitably erode ambition. 5. Recognise that establishing foundations for effective change takes years, and invest with realistic timescales. Suffolk and North East Essex ICS’ relational culture and collaborative ways of working took roughly a decade to develop, and new bodies must protect this slow work of trust-building rather than expect premature proof of transformation. Professor Ioan Fazey Department of Environment and Geography, University of York Dr Sam Buckton Department of Environment and Geography, University of York
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