The neighbourhood health service risks becoming a conceptual muddle

The government’s recent announcement that 43 places will form part of the National Neighbourhood Health Implementation Programme should be seen as a tangible opportunity to drive forward the ambitions set out in its 10 Year Health Plan. With more than 80 per cent of places in England applying for the first phase of the programme, it is clear that there is real momentum on the ground to accelerate and spread a new model of care.

However, taking a step back, it’s worth acknowledging that the aim of neighbourhoods is once again to achieve the big changes that, to date, the health service has tried and failed to achieve before.

My experience in policymaking and implementation has taught me that the more objectives a policy has, the less likely it is to succeed. This is partly because different people involved in change focus on different goals and outcomes, which can often lead to ‘conceptual muddle’. We can already see this with the NNHIP. The programme is being overseen by Sir John Oldham, who is more focused on a wider, community-embedded model of provision, while for NHS England leaders the emphasis is on NHS teams and the mechanics of the left shift.

The ambitious scope of the NNHIP should be applauded; the hope is that the 43 pioneers can grab the initiative and transform service against a backdrop of very limited investment in change and national political priorities that reinforce the current failing model of care. However, for the true transformation that is desperately needed to occur, the government needs to set out a much more compelling vision of how this could look, taking the public with them.

"Put bluntly, the shift to a neighbourhood health service must be presented as the right solution, and not simply a mechanism to bolster out-of-hospital activity"

Take the health and social care secretary’s three shifts. I see many excellent and innovative projects as I travel the country speaking to health and care leaders, but rarely have I heard an account about how these pieces of change might fit together into a wider picture that will inspire staff, patients, and communities.

We ignore at our peril the worn path that the urgent narrative and direct methods of recovery always trump that of long-term transformation. Yet politicians, policymakers, and leaders must transcend the cultural and practical divide between recovery and reform – balancing a credible long-term vision with realism about next steps.

Put bluntly, the shift to a neighbourhood health service must be presented as the right solution, and not simply a mechanism to bolster out-of-hospital activity.

The NHS Confederation has been clear that a fully implemented neighbourhood health service will need to combine a national offer with a flexible local response. Neighbourhoods need to be supported to tailor local services to meet their specific needs, with the overall aim of reducing inequality and improving the social determinants of health.

Moving to a neighbourhood model of care also has to mean resetting the relationship between the NHS, the wider public sector and communities. Alongside a shift of resources and responsibilities, key to this is increasing community resilience and building on trusted bodies and familiar expertise that are rooted in the local populations they serve – in general practice, community pharmacy, and the Voluntary, Community and Social Enterprise (VCSE) sector.

Agreeing on success metrics and their prioritisation will be key to success, both for the programme itself, but also to ensure they are embedded in other requirements the centre is setting for local leaders. A prime example is the dearth of information in the recently published league table metrics that speak to the neighbourhood aims. Forthcoming winter plans and 2026-27 planning guidance must start to address service recovery and ambitions for longer-term neighbourhood health transformation.

A helpful step would be for the Department of Health and Social Care and NHSE to develop a set of multi-year goals as stepping stones towards the 10-Year Health Plan, alongside large-scale change programmes such as the NNHIP. These should reflect both local and national priorities. Moreover, improved population health outcomes and reduced health inequalities should become the key metrics for measuring health and care services. Funding and other incentives need to be aligned to achieve such outcomes, both in the short and long term.

Putting neighbourhoods at the heart of health and care is not a minor tweak to the current model of NHS governance, nor is it a radically new blueprint for health and care, with many of our members already working in this way. Equally, there is a need to acknowledge the complexity and messiness of the policy area – problems do not come more complex than transforming and improving the population’s health. The scale of the challenge will vary as all parts of the system and wider partners come together to drive forward emerging neighbourhood models.

Despite the potential difficulties in implementation, this vision of shifting to a neighbourhood health service is the right one. A clear vision for its full implementation will be key, alongside aligned success metrics and incentives to drive forward transformation. Only then can we finally reset the relationship between the NHS, the wider public sector, and communities – ensuring that this longstanding policy slogan moves from rhetoric to reality.

Matthew Taylor is chief executive of the NHS Confederation. You can connect with Matthew on LinkedIn.