Neighbourhood health needs the perfect conditions to thrive, not a perfect model

There are many models for neighbourhood health. We’ve been writing about several of them (including the approaches taken in Fleetwood and in Singapore), most recently looking at international models in Brazil and New Zealand. Brazil’s Family Health Strategy and Healthy Families New Zealand were shaped by distinct histories and system structures, and they operate in different ways. What stands out is that their relative success depends not on the model itself, but on the conditions that allowed their approaches to take root and endure. It’s led me to reflect on whether the way in which neighbourhood health is being implemented in England is going to create the necessary conditions for transformation. 

In both New Zealand and Brazil there was a clearly defined long-term ambition and purpose. In Brazil, the aim was to make proactive, neighbourhood-based care the default model for the whole population. In New Zealand, the focus was driving community-led change to reduce health inequalities. These are different goals, but in each case they were explicit and that clarity mattered. I worry that in England, neighbourhood health risks becoming a broad label applied to a range of short-term and long-term agendas. Even if the immediate priority is reducing pressure on acute hospitals, it is still critical that neighbourhood health services are designed from the start in a way that will support longer-term transformational outcomes like tackling inequalities or shifting power to communities.

Understand that transformation takes time

Both Brazil and New Zealand created conditions that allowed investment over the long term, recognising that transformation takes a long time and needs consistent and coherent backing to match. Brazil’s national funding allowed the Family Health Strategy to scale and become embedded infrastructure. New Zealand’s multi-year, high-trust investment created space for local systems to evolve. This stands in stark contrast to the NHS’s short-term funding cycles and shifting priorities. Work that depends on building relationships, trust and community capability cannot be delivered to annual timescales. If the government is serious about the shift to neighbourhood health, it will require sustained political and financial commitment over many years. 

Neighbourhood health relies on relationships 

It’s perhaps obvious that neighbourhood health is fundamentally relational work and offers the opportunity to reset relationships between services, people and communities to support a more holistic and preventative model of care. This relational work depends on clinicians, care professionals and other community roles to work together to build continuity, trust and understanding. In Brazil, community health workers build ongoing relationships with households, supporting early intervention and continuity of care. In New Zealand, system connectors enable collaboration across services and strengthen community leadership. In England, similar ambitions sit behind roles such as social prescribing link workers. But too often these roles are treated as peripheral, subject to short-term funding and poorly integrated with the rest of the system. Integrated neighbourhood teams could help make relational and preventative work sit at the heart of local care, as a core function of all members of the team. 

The wider system needs to support neighbourhood health 

Finally, both international examples highlight the importance of aligning the wider system. Funding models, workforce structures and approaches to measurement need to support neighbourhood health, not work against it. This is particularly evident in how success is measured, and that is complex because it does not fit neatly into conventional performance metrics focused on activity over the short term. If neighbourhood health is judged solely on short-term outputs, will it ever be seen as successful?

Examples from Brazil and New Zealand show neighbourhood health not as a technical reform bolted onto existing systems but a complete shift in how services relate to people and communities. I think that if neighbourhood health in England is going to drive a similar sort of transformation, local and national leaders need to think carefully about how to create the conditions for it to succeed. The central challenge lies in aligning ambition, funding, workforce and measurement to support long‑term, relational, community‑centred care. Without this, neighbourhood health risks remaining a compelling idea, or a small-scale reorganisation of teams, rather than the transformation that will be needed for a sustainable health and care system in the future.