CEO blog - An NHS solution is not enough: Neighbourhood Health is public service reform

An NHS solution is not enough: Neighbourhood Health is public service reform

Neighbourhood health is not simply an NHS reform programme. It should be part of a wider public-sector reform agenda. The central challenge for public services is no longer only how they respond to today’s pressures, but how they work together to address the conditions that create tomorrow’s demand.

Sustainable improvement is most often achieved where leaders work across boundaries, build trusted relationships, and involve communities and people who use services in shaping solutions. Where performance remains fragile, the underlying challenge is frequently not a lack of effort, but a failure to connect effectively with communities and people with lived experience beyond the walls of individual services. The strongest local areas recognise that hospitals, councils, housing providers, voluntary groups, and communities all contribute not only to health outcomes but also to health care outcomes. The weakest often remain focused on protecting institutional interests rather than improving collective results.

Lessons from improvement and regulation

Experience from service improvement programmes consistently shows that lasting recovery rarely comes from technical fixes alone. Organisations that move from inadequate performance to sustainable improvement usually recognise that the status quo is no longer viable, involve staff and communities in shaping solutions, and build stronger relationships with partners across their local area. CQC's Beyond Barriers work highlighted both the potential and the limitations of earlier integration efforts. The strongest places aligned leadership, resources, and priorities around shared outcomes. However, funding arrangements, accountability mechanisms and performance systems often encouraged institutions to focus on their own objectives rather than on population outcomes.

Demand Is created outside the NHS

Accident and Emergency pressure is often described as an NHS operational challenge, but the evidence points to something much wider. Health and social care issues caused by poverty, poor housing, loneliness, frailty, unmet mental health needs, and gaps in social care frequently appear at the emergency department front door.

The strongest urgent and emergency care systems understand the pressures facing themselves and their partners, and act with them. They take today’s operational pressures seriously while equally addressing the conditions that create tomorrow’s demand. Moving services closer to home is important, but it is only part of the solution. Leaders must also influence the social and economic factors that shape health outcomes and do this through collaboration with partners across the wider system.

Neighbourhood Health as reform of the public’s services 

Andy Burnham’s arguments for devolution reinforce a broader shift in thinking. Neighbourhood working is increasingly moving beyond health policy and becoming a wider model for public sector reform. This matters because many of society’s most complex challenges cannot be solved by any single agency acting alone. Health, housing, employment, education, community safety, and social care all influence each other's outcomes. Neighbourhoods therefore become not simply locations for service delivery, but places where public services align around people’s needs. Joining together within the state is very hard, but unless it involves the public themselves in a co-produced and meaningful way, it is of limited value. The implication is significant. Neighbourhood working is no longer a desirable innovation at the margins of the system. It is increasingly becoming the expected operating model for commissioning and delivering better outcomes with finite resources.

The government's Neighbourhood Health Framework now describes neighbourhood health as a joint endeavour between the NHS, local authorities, adult social care providers, and wider partners. The opportunity is to turn that policy intention into shared decisions, shared responsibility, and a genuine role for communities. It must guide any future operating framework the NHS deploys.

Financial flows and prevention

The financial rules of health and care remain a major practical barrier. Hospitals carry large fixed-costs, councils manage separate and constrained budgets, community organisations often depend on short-term grants, and the financial benefits of prevention are frequently realised elsewhere from where the investment was made. The 10-Year Health Plan for England acknowledges this problem and proposes new funding flows, including year-of-care payments, intended to support proactive and planned care. These mechanisms will matter, but their success will depend on whether they encourage local partners to invest together and share both risk and benefit over time.

From treating illness to creating health

Perhaps the biggest shift is cultural rather than structural. Culture has evolved in response to structures. Traditional services have largely been designed to diagnose and treat illness. Neighbourhood working requires a broader focus on wellbeing, resilience, independence, social connection, innovative thinking, and community capacity. Recent reviews from Greater Manchester, Leeds and Calderdale show that the most mature systems define success not merely as treating illness efficiently, but as helping people remain healthy, connected, empowered, and independent for longer. They frame health as a shared civic responsibility rather than solely a clinical one.

In the end, the lesson from the strongest local systems is clear. Better outcomes are achieved collectively. Public services, funding arrangements, and regulation now need to reflect that reality. Neighbourhood health is not simply an NHS project. It is a much bigger public sector reform.

William Greenwood

Chief Executive