Neighbourhood health: the idea isn’t radical but implementing it would be

Neighbourhood is the health policy buzzword of the moment. ‘Neighbourhood health service’, ‘integrated neighbourhood teams’, ‘neighbourhood working’ – these are just a few of the ways it’s being used. You could be forgiven for thinking this is a new policy solution, a radical innovation, a single answer to the myriad problems facing health and care.

To accompany the long-awaited NHS planning guidance for 2025/26, NHS England (NHSE) published its Neighbourhood health guidelines, setting out how it expects NHS bodies to put these ideas into practice.

Standing back from the detail, what is clear is that neighbourhood health is not a new ‘thing’ at all. Using population health management tools; improving access and continuity in general practice; strengthening core community services; establishing integrated multidisciplinary teams to support people with complex needs; offering intermediate care (encompassing short-term rehabilitation, reablement and recovery services); delivering urgent community-based services for people with escalating or acute health needs (including urgent community response and hospital at home/virtual ward services) – these are the six core components of neighbourhood health that NHSE’s guidance asks systems to focus on delivering consistently and at scale over the next year for people with complex health and social care needs. All these components are things that many areas have been working on for years, albeit badged differently under the rubric of integrated care or place-based working.

In the longer term, the guidance sets an ambition for systems to move to a broader approach to neighbourhood health, focusing on population groups with less complex needs to enable more people to be supported in their homes and community settings, and to connect people to wider public services and third-sector support that can improve health and wellbeing. This matters because most of what determines our health and drives health inequalities lies outside of the remit of health and care services and is driven by the physical, social and economic contexts in which we live (the wider determinants of health).

So, is the lack of ‘newness’ in the neighbourhood health guidance a problem – an indication that the ambition isn’t great enough or that the policy doesn’t match up to the enormous scale of the challenges facing health and care? On the contrary, this could be one of its greatest strengths. The experience of systems that have had some success in shifting to a more community-focused approach shows that this isn’t achieved through a single policy solution, but instead through the aggregation of many simultaneous changes to the way in which care is organised and delivered. Although the component parts of neighbourhood health may not be new or radical, implementing them everywhere as part of a movement to fundamentally reorientate the health and care system would be.

Experience shows that this won’t be easy. Despite similar past attempts, the focus of resources and attention has consistently driven the health system to prioritise hospital services at the expense of community-based care. One of the most important things this guidance does is to balance a focus on new models of care (such as integrated neighbourhood teams and virtual wards) with a focus on strengthening the fundamental building blocks of community-based care, namely general practice and community health services. A lack of resources and attention for these vital services are one of the explanations as to why 30 years of policies intended to deliver care closer to home have proved largely unsuccessful. Funding and staff numbers have grown faster in hospitals than in primary and community services, while numbers of some key community staff groups, such as health visitors and district nurses, have declined. These trends need to be reversed if ambitions for a neighbourhood health service are to be realised.

When reading the guidance, it’s hard not to notice the fundamental tension in trying to drive the shift to a neighbourhood health system from the centre. Delivering services in communities for communities is an inherently local undertaking, and a neighbourhood health service that is suited to one setting or population will look different to what would be required elsewhere. The guidance attempts to recognise this and to strike a balance between offering national direction while leaving space for local determination. Getting this balance right will be a key challenge when it comes to the implementation of ambitions around neighbourhood health going forward, and for NHSE’s national implementation programme that will be developed over the coming months. This is a familiar challenge, and one that NHSE and other national bodies have attempted to navigate before (with varying degrees of success), for example during the implementation of the new care models programme.

Finally, for all its promise, there is a potential major pitfall in the NHS’s newfound enthusiasm for neighbourhood health. Namely, that it risks being too narrow and crowding the role and contribution of key players – in particular local government, the voluntary and community sector and communities themselves – that have a central role in creating healthier neighbourhoods and communities. The prioritisation implicit within the short-term and longer-term asks in NHSE’s guidance reflects the current national focus on addressing pressures on acute hospitals, with efforts to strengthen community and primary care services being seen first and foremost, in the short term at least, as a means to achieving this. But this risks missing the point of what shifting to a neighbourhood health service is all about. While NHSE may be asking systems to focus first on health and care services for those with the most complex needs, many local places already have well-established approaches to working with a wider set of partners to support community health and wellbeing more broadly. It may be challenging for local NHS leaders (including those in integrated care boards and provider organisations) to look both ways, but ultimately that will be the only way to create a neighbourhood health service that can truly shift the dial on improving population health.