Government drive to move the NHS to a neighbourhood health service must involve local communities

The country’s rising demand for health and care services, coupled with the need to drastically improve the health and wellbeing of the population, reduce health inequalities and boost the economy means fundamental changes are needed to the way health and care services engage with their neighbourhoods and communities. 

A new NHS Confederation report warns that while the government has emphasised the importance of this shift to a “Neighbourhood Health Service”, across many parts of the country, especially in some of the most deprived areas, the health and care systems need to adapt their operating model to the communities they serve.

The report, ‘The case for neighbourhood health and care’ published in partnership with the Local Trust and  PPL says that the NHS must work with communities and neighbourhoods more closely.

It recommends that to address the productivity challenges it faces, along with rising patient demand, the NHS needs to do this to tackle the worsening and widening health inequalities across the population. 

It says that effective neighbourhood working will also require both ‘positive’ devolution of powers to communities and ‘negative’ devolution so that the government lets go of some of the reins and allows for the creation of community-led innovation and growth.   

It also states that clear involvement of local people and their communities is essential to the government’s vision for creating neighbourhood health services.

It finds that there is still much work to do to create integrated approaches to health and wellbeing.

Recommendations include the need for clarity on the role of the NHS and the level of reform needed across the health service to ‘move from pockets of excellence to widespread shifts’ in strategy as well as the resources needed to do this. 

Further proposals include: 

• The need to recognise the shift to a community-first approach as one of the largest transformation programmes in the statutory sector's history, and to support it accordingly. 
• Shifting the NHS to multi-year funding and planning cycles, aligned with local authorities, to allow for long-term planning and speed up integration between health and local government. 
• Reforming the GP contract with more devolved accountability to strengthen primary care’s role in neighbourhood health models. 
• Involving local health leaders in growth policies and funding programmes that maximise local impact and resources. 

There also needs to be a much stronger diagnosis of the impact of declining assets and infrastructure within communities, and more attention paid to the work needed between local statutory partners to reverse that decline.  

Matthew Taylor, chief executive of the NHS Confederation said: 

“To secure its future for the long-term the health service must go back to its roots and founding principles and garner much greater involvement in its services and structure from those it serves. 

“The evidence shows that when statutory organisations in our neighbourhoods genuinely collaborate with their communities, we can unlock the potential for greater economic, social, mental, and physical prosperity. This isn’t just an idea—it’s a proven path to genuine and long-lasting impact. 

“By working together with our communities, in our communities, and for our communities, we can start to turn the tide and reach the goal of reducing health inequalities from an aspiration into a reality.”

Rachel Rowney, chief operating officer of Local Trust, said:  

“The case for change report sets out the importance of community-led services in making integrated neighbourhood working a reality. It includes examples from some of our Big Locals, offering inspiring models for what can be achieved when communities are at the centre of the decisions which impact and support them. 

“The strongest examples demonstrate that it is possible for statutory partners and community sector partners to work effectively together at the neighbourhood level. They champion dynamic, asset-rich neighbourhoods, making their own decisions on what is best for their area.

"This is the first output of the Local Trust and NHS Confederation's partnership and it’s not the last. We’re very eager to continue to shine a light on the successes and challenges of neighbourhood partnerships and want to thank all the people across the country who are showing that communities are at the heart of change.”