Why has the vision of neighbourhood health been so hard to realise?

In 1982, my parents – who were both social workers at the time – helped to set up a community mental health centre in Downham, Lewisham, known as the Northover Centre. The idea for the centre was born from a series of meetings my mum’s team held with local residents, many of whom felt disconnected from services based in the centre of Lewisham. The message from the community was clear: they wanted accessible, joined‑up mental health support, rooted in their neighbourhood.  

What followed was a five‑year project, jointly funded by health and social services, to transform an unassuming council storeroom behind a GP surgery into a vibrant community mental health centre. The Northover Centre offered a wide range of support for local residents, who could be referred there by a health or care professional, or simply walk in. On site were social workers, a housing specialist, a welfare rights officer, counsellors, community psychiatric nurses and a psychiatrist. The centre provided childcare, as well as space to relax, and connect with others, through activities like board games, table tennis, and arts and crafts. Importantly, this was not just about bringing services together but about working with the community to create a space that reflected people’s needs.

For those involved – both professionals and service users, some of whom went on to become volunteers – the Northover Centre was more than a service. It was a place where people felt known, supported and a real sense of belonging. It offered continuity of care and created the conditions for the community itself to thrive.

Neighbourhood health is often presented as a new direction for the health and care system. But as the example of the Northover Centre shows, it reflects ways of working that we have seen before – built on relationships, rooted in communities and designed around people’s lives.

These same principles sit at the heart of current policy. The government has placed a new neighbourhood health service at the centre of its vision for the NHS, aiming to help people live well locally and reduce reliance on hospital care. This reflects commitments in Labour’s election manifesto to shift care closer to home and is reinforced in the 10 Year Health Plan, which sets out the government’s ambition for more convenient, community‑based care.

At The King’s Fund our recent long read explores how these ambitions are being realised in two international systems and what we can learn from them. In Brazil, the Family Health Strategy places neighbourhood-based care at the core of the primary care system, with multidisciplinary teams (including community health workers) providing proactive outreach in people’s homes. In New Zealand, Healthy Families takes a different approach, focusing on community-led prevention and systems change by reshaping local environments, relationships and decision-making. For example, working with local organisations, businesses and communities to reimagine public spaces.

Despite their differences, these international models share some important features. Both place relationships, community knowledge and an understanding of people’s wider lives at the centre of care. Both show how relational ways of working underpin approaches to service delivery and prevention. And both demonstrate that neighbourhood health is not just about where care is delivered, but how it is organised around people and communities.

These approaches are, of course, not unique. In many ways, they reflect ways of working that exist much closer to home, such as The Hub in Fleetwood, The Progress with Unity Plan in Wigan, the Healthy Communities Together sites and many other examples of the public sector ‘doing with’ communities, instead of ‘doing to’.

The principles that underpin neighbourhood health – trust, continuity and community leadership – have long existed in practice, though often in isolated pockets. Indeed, there are many examples – past and present, in England and elsewhere – of neighbourhood health working well: where the conditions for care are built around local relationships and places, not just shifting activity from one place to another. As the Northover Centre and other examples show, there is much to learn from what has come before.

We also have a growing body of evidence about what supports these approaches. And there are many people within the system who want to work in this way and have the skills to do so. So why do these approaches remain the exception rather than the norm?

There are many contributing factors. But a central challenge is that the health and care system in England is not configured to support such relational ways of working. Services are often shaped by short-term priorities, fragmented funding and a focus on discrete activities, making it difficult to create the time, continuity and flexibility needed to build trust and respond to the realities of people’s lives.

As I prepare to go on maternity leave, and with my first child soon to be born in Lewisham, I found myself thinking about what the system might look like by the time they’re older. I hope they won’t be asking why services don’t reflect the realities of peoples’ lives and their health and care needs. Instead, I hope they will be able to look back – at the work of their grandparents and countless others – and see the principles of trust, continuity and community leadership embedded in how care is designed and experienced by everyone.