Delivering the left shift: the 24/7 neighbourhood mental health pilot sites

About the neighbourhood mental health centres

In July 2024, NHS England announced the launch of six 24/7 neighbourhood mental health centres as part of the government’s wider neighbourhood health agenda, which includes the National Neighbourhood Health Implementation Programme (NNHIP), Pride in Place Strategy, Test Learn and Grow (TlG), and Community Help Partnerships.  

From 37 applications, the six chosen pilot areas aim to promote continuity of care, an integrated one-team approach for service provision, patient safety, improved clinical outcomes and reduce the need for admission to hospital.  

The centres are based in local neighbourhoods and expected to be open to all people who are experiencing mental health problems, with a specific focus on people with severe mental illness (SMI) via open access and referrals.

Services include crisis assessment; short-stay beds; psychological interventions; medication; per support; primary care support; social prescribing; home treatment and outreach; and advice for housing, welfare and employment.

The 24/7 centres are set up to serve a defined neighbourhood of around 30 to 50,000 and designed to be more rooted in local communities than other mental health community services that may cover larger geographies. The centres aim to provide care and support closer to where people live, applying and adapting them to meet local needs and supporting existing relationships with grassroots and VCFSE (voluntary, community, faith and social enterprise) organisations.

People will be able to receive culturally appropriate support from professionals including mental health nurses, social workers, voluntary sector workers, peer support workers, psychiatrists and psychotherapists. 

In February 2026, high-level implementation guidance was shared with integrated care boards (ICBs) and is available on NHS Futures, which sets expectations for further roll out of neighbourhood mental health centres.

Funding and operating models

Each pilot area received a grant towards revenue costs for two years of operation, which comes to an end in April 2026. A further 16 sites were given associate status but received no additional funding.

The pilots are run as a partnership between the NHS, local authority, social care and VCFSE (voluntary, community, faith and social enterprise) organisations, and co-designed, developed and evaluated by people with lived experience.

They draw heavily from models that have been developed over many years and are part of a swell of community transformation including the One Life service in Hartlepool, VCFSE-led approaches in Somerset and Lincolnshire, and from international examples of community mental health care that are endorsed by the World Health Organisation, including the Trieste model in Italy.

The pilots reflect the key elements of the 2019 Community Mental Health Framework, which set out that a modern service for adults with severe mental illness should be accessible, connected to non-clinical support, partner with the VCFSE and primary care sectors, and informed by and designed around the needs of local communities.

Pilot sites were intended to start operation from spring 2025. However, the ambitious timetable and challenges including estates, contracting and workforce recruitment have slowed implementation. Sites are taking a phased approach, are at different stages of delivery and none have yet completed a full roll out. As of March 2026, all six centres are seeing and treating patients, with three sites operating a 24/7 service with open access during daytime hours, and three sites providing care and treatment to existing patients without operating 24/7.  

Core principles of 24/7 neighbourhood pilots

These principles are based on international evidence and co-produced with people and families.

Characteristics of the six sites

While the six sites have taken different approaches in order to meet local need and make most efficient use of existing estates and services, there are specfic aspects that characterise the models:

• A physical centre, easily accessed by those within a defined area. However, support is not limited to people coming into the centre – home treatment, services ‘on-wheels’ and meeting people in other places accessible to them continue to be part of the model.
• Open Access, which is being delivered and understood in different ways. All sites are committed to achieving walk-ins as a new way to access secondary care mental health services, in addition to traditional referral routes.
• Bringing together a range of community-based secondary care mental health services, which are often located in different places and organised in different ways, into a single co-located team. This includes services such as home treatment teams, community mental health teams and, in some places, more intensive support such as assertive outreach teams.
• Co-location, or at minimum, connected support from VCFSE organisations to deliver non-clinical support in the same spaces and at the right time.
• All will be expected to provide 'hospitality beds', which are modelled on the approach taken in Trieste. These are not inpatient beds, but are more similar to crisis or step-down beds and will allow teams to support someone overnight, or on a very short-term basis, to fully assess and understand the persons’ needs in a calm, non-restrictive environments, avoiding admission to an inpatient bed or sending someone away from the centre who they fear may become more unwell.
• Stronger links to primary care, ranging from primary care support embedded in the centre to close links to surgeries to provide advice on physical health needs. This includes shared roles with primary care or integrated neighbourhood teams.

Expected outcomes and benefits

• Evidence for a sustainable and cost-effective community model that can be replicated beyond pilot sites.
• Individuals will be able to access the support they need, when they need and in a place that is convenient for them. They will have all their needs understood, leading to better coordinating of support services to coalesce around the person, reducing duplication and improving system efficiencies.
• Greater integration of the biological, psychological and social aspects of good mental health care across health, social care and the VCFSE.
• Improved clinical and patient satisfaction outcomes by improved support and management of community-based mental health care.
• A reduction in inpatient admissions, bed days, and emergency department attendances through preventative or pre-emptive care, with a related greater use of community-based settings.
• A decrease in the extent of, or potentially need for, waiting lists for some mental health support due to an open access approach.
• Improved interface between primary and secondary care including more efficient referral and discharge processes, and improved physical healthcare for people accessing the centres through stronger links between GPs and mental health professionals.
• Better health outcomes that go beyond clinical symptoms as patients have easier access to preventative clinical and non-clinical care depending on their needs. This includes interventions such as support with employment, housing, substance use, reducing the decline in wellbeing and reducing the risk of crisis.
• Reduction in health inequalities due to more culturally sensitive support and improved relationships with local communities.
• Organisational culture change that fosters a positive work environment and improves staff experience and retention through the creation of an integrated team identity. 

The six pilot sites

Community involvement in design and development

While all six sites have involved communities in the design and development of the neighbourhood centres, the process around co-production has varied. Key themes centre on deep, ongoing coproduction and broad, inclusive community involvement. There are strong commitments to equity and community ownership, actively involving underrepresented groups, commissioning grassroots organisations, and giving community members real decision-making power.

• Copeland held consultation events prior to and during the development period allowing for the community to co-produce the service model, name and branding. The Lived Experience and Peer Support leads have undertaken consultation with various service user groups both in secondary care services and local communities.
• In Heeley, during 2025–26, over 450 people, including service users, staff, primary care colleagues, voluntary sector partners and community champions, took part in over 25 engagement and co‑production sessions. These sessions informed everything from the design of the buildings and interiors to how mental health teams can work differently in future.
• Birmingham East Central had early engagement with a diverse range of local community partners and to co-produce the delivery model from initial bid submission to present date. The centre established a community partner steering group that feeds directly into the project governance structure. They have also ringfenced funding to create opportunities for community partners to deliver community-led projects in partnership with the centre using a small grants fund approach. As a result, they have commissioned 12 local grassroot VCFSE providers, as delivery partners, to deliver a range of non-medical interventions to support in addressing social determinants of health.
• Lewisham held intensive pre-bid engagement involving extensive outreach with local VCFSE groups, service users and carers and other local partners, to continue raising awareness, develop understanding of needs and gather feedback to help shape proposals. Various themed workstreams involving various stakeholders were launched in spring 2025 to progress development of the model, with ongoing partner engagement through briefings and standing meetings to share plans and gather feedback. There was also a number of online and in-person engagement events with service users and carers relating to the interior design of the new centre.
• Acomb held four full-day co-production sessions that directly shaped the centre’s look and feel, delivery model, out-of-hours offer, use of physical space and the approach to processes and integration with connected services. Community members and centre users have also selected décor, influenced location and building design plans, and have been part of all-staff interview panels with equal decision-making power to professionals. Acomb also did targeted outreach to underrepresented groups such as Gypsy, Roma and Traveller communities, LGBTQ+ people, neurodivergent individuals and refugees. Ongoing involvement is embedded through regular conversation cafés, providing continuous opportunities for the community to shape, challenge and improve the centre and ensure it remains inclusive and responsive to local need.
• Tower Hamlets has involved the Tower Hamlets Mental Health Partnership Board since November 2023 in the design and governance of the pilot site and held weekly meetings over several months in 2024. There are ongoing co-production meetings held bi-weekly with residents, service users and carers with high rates of attendance and engagement. Tower Hamlets has encouraged service users and carers to remain involved with the site and take ownership of the environment.

Evaluation

NHS England has commissioned Ipsos, UCL’s Division of Psychiatry and Centre for Mental Health to conduct a national evaluation of the pilots, which sits alongside and complements local evaluations that some areas have commissioned. The evaluation will conclude with a final report in Summer 2026.

The national evaluation has co-produced research with lived experience researchers by taking a co-designed approach between UCL, Ipsos, Centre for Mental Health, NHS England, Expert by Experience network and lived experience researchers. 

The learnings from this so far have included emphasis on relational ethics, peer reflection, bespoke training rooted in empathy, presence and care and continuous reflection and safeguarding support built in. 

Summary of progress to date

The 24/7 pilots have great potential to further improve and expand the community mental health offer, better meeting the needs of patients, reducing use of emergency and hospital services and supporting the government’s left shift. Some sites are already reporting positive impacts and looking to adopt the model in other localities. Others are reflecting on how you can ensure key ingredients are in place and available to people where a physical centre may not be possible in the short-to-medium term.

The additional revenue funding for the pilots is welcome, but there is the expectation that services will be funded through existing budgets after the end of the pilot stage in March 2026. The ambition is that these new models will release costs from the wider system and produce efficiencies from redesign of existing teams across NHS, social care and VCFSE into one neighbourhood team. However, funding them long term will be difficult given the tough financial envelope the system faces, and the length of time that wider systems savings will take to be realised. 

The variation between the six models and their locally defined success measures makes national evaluation complex and potentially less effective, although the variation offers an opportunity to understand which approaches help to achieve the principles and desired outcomes best in order to inform a more standardised model. Delays in opening the centres has also meant the evaluation is likely to have had to focus more on challenges in setting them up, rather than capturing measurable impact. Two areas have separately commissioned additional academic local evaluation to understand impact and return on investment. However, evidence from across the sites that shows which aspects of models genuinely reduce demand on wider services and improve patient outcomes, will help ensure any future rollout is effective and worthwhile.

As capital funding was not made available to the sites, areas have taken varied and innovative approaches to ensure they have fit-for-purpose facilities for the centres. This has slowed progress in many areas. Using NHS and partner estates effectively is key to succeeding in delivering neighbourhood-based models, we explore what is needed to help accelerate estate solutions for neighbourhood-based models in our February 2026 member briefing.

Recruiting staff and agreeing contractual arrangements with partners within the tight national timelines is also a reoccurring issue, alongside substantial national reporting requirements.

The inclusion of ‘hospitality beds’ in the sites will need to be closely monitored to ensure they work for patients and do not become de-facto inpatient beds within the community. We can learn from the slightly different approaches the pilots are taking towards striking the balance between ensuring the beds are a therapeutic non-clinical space – a need for which has come out strongly from engagement with people with lived experience - while also being safe and navigating regulatory standards. 

Due to the high level of physical health inequalities for people with SMI, strong links with primary care are vital. While the skills to support individuals’ physical and mental health can be distinct, they are also complementary. Integration with primary care is currently variable between the sites. There is concern among members that progress on wider neighbourhood health models is moving in parallel to the development of new mental health neighbourhood approaches, which risks undermining the core aim of neighbourhood health of delivering more integrated care. The development of broader neighbourhood working models should recognise the 24/7 pilots as valuable neighbourhood infrastructure, and the pilots need to engage with wider models in a strategic and assertive way. NHS England’s Neighbourhood Health Framework, published in March 2026, included people with a mental health need in some definitions of a ‘high-priority cohorts’ and over the longer term (April 2027 – 2029) requires neighbourhood models to confirm how the mental centres align with their overarching strategies. Our member briefing of the Neighbourhood Health Framework provides a summary of the framework and our analysis.

Analysis and requirements for success

The Neighbourhood Mental Health Centre 24/7 pilots are just one piece of the broader neighbourhood agenda and one element of the whole mental health eco-system. They alone cannot meet the needs of people with severe mental illness. The Modern Service Framework for SMI has huge potential for shining a light on access to evidence-based treatments and reducing variation. We need continued focus on assertive and intensive treatment, implementing and realising the ambitions of the new Mental Health Act and improving mental health emergency care. The 24/7 models must be seen as one piece of the transformation puzzle.

The 24/7 centres reflect the core elements of and are an evolution of the community mental health framework and crisis care trandformation. The allocation of additional capital over the next four years will support further roll out in some areas. However, there will still be challenges, particularly in securing dedicated funding to roll out centres across the country within the next few years. Despite these pressures, we know that mental health trusts and VCFSE partners are increasingly finding imaginative ways to deliver the core ingredients of the 24/7 centres to better meet the needs of their patients and communities. 

While the evaluation has not been completed, it is already clear that four elements will feature in the success of further expansion of this model: 

These four elements also reflect what is required for the success of wider neighbourhood health approaches. The health and care system must be supported by the Department of Health and Social Care and NHS England to drive further progress in these core components, and local systems must ensure they are all underpinned by strong community engagement and co-production.

We will continue to work with our members from across the system to share and build on the good and innovative work of the sector. Over the past 18 months we have played a leading role in developing the neighbourhood policy landscape and we will continue to ensure that our members’ voices shape national policy. 

Further information on our work on neighbourhood working and access to a range of resources can be found at our neighbourhood working centre.