Navigating neighbourhoods
Senior Researcher
The Government have committed to the creation of a new NHS, what they call a ‘Neighbourhood Health Service’, the key vehicle through which they’ll deliver a promised shift of care from hospitals to communities.
The temptation, as often occurs in health and care reform, will be to reorientate existing governance structures, such as ICSs and Primary Care Networks, around neighbourhood health, and to issue comprehensive guidance on what kinds of services and parts of the workforce should be involved in delivering neighbourhood care in each area.
Implementing neighbourhood health in this way, however, would mean sacrificing the potential of local systems to experiment, respond proactively to the needs of individual communities and begin taking a more social (less medicalised approach) to health creation. Rather than dictating what neighbourhood health looks like in every patch, government should unleash the dynamism of local leaders and communities to rebuild primary care for the 21st century.
Based on interviews with leading health sector experts, Re:State has today published a blueprint to guide policymakers in designing a neighbourhood health service. Examples across Britain demonstrate the huge opportunities that exist to do things differently. Our report distils these into practical case studies — with key lessons that can be taken from each.
Below, three core components that are shared by the most mature neighbourhood systems.
Leadership to drive neighbourhood-level change
Long-term change depends on the presence of inspiring leaders, who can galvanise people around an ambitious goal but also grant them the flexibility to try (and sometimes fail) to implement new ways of working. Neighbourhood leaders are most likely to be successful when they are embedded in existing networks, and given the power and investment needed to be bold in delivering change.
Interviewees told us that current neighbourhood-level strategies are too top-down and are generally GP-led. Meanwhile, other avenues for local leadership, like Health and Wellbeing Boards, are significantly under-utilised. And many examples of neighbourhood innovation are driven outside of these formal structures, by community champions, the voluntary sector and faith groups.
We should be agnostic about who is best placed to lead change, while ensuring that resources flow towards local leaders who can make the most impact.
Understanding of the determinants of health
It’s at a neighbourhood-level where the health system has the greatest leverage over the factors which enable people to live in good health: strong relationships, high-quality housing, green space to exercise, opportunities for fulfilling work.
Yet to act, neighbourhood health systems first need to know. This means breaking down siloed datasets between different health and care providers, local government and the VCSFE sector — allowing leaders to understand what affects population health in their area, and develop targeted interventions to boost these wider determinants.
Interviewees pointed to pioneering examples of data partnerships at a neighbourhood-level, particularly with universities that can help sift through and analyse data to direct resources towards residents with the greatest health risks and needs.
Creative deployment of workforce and neighbourhood assets
Interviewees argued that some of the most valuable neighbourhood assets do not easily “map onto” NHS services, meaning they are overlooked by commissioners and are often not well-integrated with mainstream services.
Building an effective neighbourhood health system means having ways of identifying, scaling up and integrating these assets — whether a leisure centre that runs open-access health classes, a community group that supports people to change their diet, or a faith site that helps connect lonely people — to ensure they are well-utilised and achieve their greatest impact. Similarly, at a neighbourhood-level, less medical parts of the workforce, including link workers, citizen leaders, and health and wellbeing workers, make a vital contribution.
High impact neighbourhood health is largely about valuing and being versatile enough to benefit from what already exists; not reinventing the wheel.
This project was kindly supported by Boots.