Neighbourhood health: why is it different from what has gone before?
Neighbourhood health has been touted as the biggest change to the NHS in years. But is it really different to policies and programmes we’ve seen in the past? Sewell Advisory’s Louise English examines the case.
The publication of the NHS 10 Year Plan and the emergence of neighbourhood health as a central delivery model sit at the heart of NHS reform and signify a new era for the NHS. Neighbourhood health represents a structural overhaul of how care is being delivered, and crucially builds on earlier models in several key ways.
Is this a case of déjà-vu?
Similar approaches to integrated care have been trialled repeatedly throughout the history of the NHS, dating back to a concept identified in the Dawson Report of 1920, which proposed a network of primary and secondary health centres linked to hospitals. Early plans failed due to a lack of political support and the cost of establishing new health centres to accommodate co-located services, alongside a fear that these networks would dilute the traditional family doctor-patient relationship, as was common in those days.
In the 1930s, health centres began to establish themselves in London. Examples include the Peckham Experiment and Pioneer Health Centre, which offered a holistic model of health rather than disease, and a range of health and wellbeing services that reflect the principles of neighbourhood health as we understand it today.
More recently, the 2008 Darzi Review recommended the establishment of polyclinics, a service model of health and partnership working that gives greater control to patients over when, how and where their health and social care needs are met, and refocuses care from cure to prevention.
There is commonality between neighbourhood health and what has come before: a drive to better integrate services; more care delivered outside of a hospital setting; and a focus on prevention.
However, neighbourhood health marks a more ambitious iteration, building on previous models and broadening the focus.
What is different this time?
Defined neighbourhood footprints
Neighbourhood health guides systems to build a service model around the needs of a defined neighbourhood footprint – a population of around 50,000 patients – rather than simply relying on collaboration between organisations or the co-location of services without true integration.
Stronger national policy while keeping local needs at its heart
It is clear that local systems have autonomy in designing models for their neighbourhoods; however, the guidance provides much clearer direction on expectations, outcomes, governance arrangements and national implementation frameworks.
A truly integrated public service model
Neighbourhood health is not solely about health but about population health management and reducing inequalities. It requires the true integration of public services to allow the population to live as healthily and independently as possible, for as long as possible, and to receive care and support within their local community.
This requires the NHS, local authorities, social care, public health, housing, and voluntary and community organisations to work together to meet the needs of the neighbourhood.
Funding and incentives
Previous models failed due to a lack of fundamental change to commissioning, contractual arrangements and funding flows. The need to create multidisciplinary teams to serve neighbourhoods will be supported by Multi-Neighbourhood Provider and Single Neighbourhood Provider contracts, and by the phasing out of block payments in favour of activity-based models that reward patient outcomes rather than the volume of activity.
Stronger emphasis on infrastructure to realise the ambitions
The estate is often spoken about as an enabler; it is essential to realising the ambitions of the programme. The physical infrastructure required to realise the ambitions has been carefully considered, creating a framework for estates investment and delivery.
Building a digital ‘backbone’
The success of multidisciplinary teams will require modernising the digital infrastructure used to support patient care.
What will determine success?
Success will not be judged by the vision itself, but by whether the NHS can finally achieve what previous initiatives struggled to deliver. Systems are required to design new models of integrated health and social care, with neighbourhood needs at their heart.
Key to realising the ambition are:
- A sustainable workforce model that enables multidisciplinary teams across organisational boundaries.
- Funding flows and incentives that support care closer to home.
- Digital infrastructure and shared data.
- Strong local leadership, with clear accountability for delivery across all system partners.
- Clear, measurable outcomes that demonstrate whether neighbourhood health is improving access, experience, prevention and population health.
Neighbourhood health has the potential to succeed. But it will only be different if there is a wholesale structural overhaul of how care is planned, commissioned and delivered. The will is there from all partners to make it work, but it needs true integration to ensure the change is lasting. Only time will tell if neighbourhood health becomes the new default for the NHS, or if it will just be another footnote in history.
A Chartered Commercial Property Surveyor, Louise English spent a decade working in the NHS, before joining us in 2023 to help advise healthcare organisations on how to achieve their estates ambitions.
She is one of a number of experts at Sewell Advisory who can navigate you through the challenges of planning and implementing your neighbourhood health goals.