Neighbourhood Health Guidelines: What will it take to shift the system?

blog | Words Christina Cornwell | 21 Feb 2025

NHS England recently published their much-anticipated Neighbourhood Health Guidelines, including the announcement of a National Implementation Programme to help local places begin to shift care from hospital to community, and from treatment to prevention:

“Neighbourhood health aims to create healthier communities, helping people of all ages live healthy, active and independent lives for as long as possible while improving their experience of health and social care, and increasing their agency in managing their own care.” 

At Innovation Unit, we’ve been supporting the development and spread of neighbourhood models across the UK for over 20 years. We want to offer our insights on how the National Implementation Programme can overcome decades of inertia, address the urgent problems in the NHS, and grow a new preventative neighbourhood health system by:

• Reimagining the purpose of our neighbourhood health system
• Realising agency through actionable learning
• Growing power for communities, patients and carer
• Creating a coherent roadmap for system change

1. Reimagining the purpose of our neighbourhood health systems 

Many parts of the country have already set out on an ambitious journey to transform neighbourhood health systems – from modernising primary care, to establishing integrated neighbourhood teams.  The new Neighbourhood Health Guidelines provide welcome momentum and coherence – a shared and inspiring vision for a more person-centred approach that’s rooted in local priorities and relationships.

However, the breadth of the guidelines – covering the full range of primary, community, intermediate and urgent care services, as well as integrated teams – can feel overwhelming, especially when resources are so tight. There is a real risk that short term imperatives and pressures mean that all the focus and attention is on rearranging existing NHS services, neglecting the bigger prize of a much more preventative, community centred approach to neighbourhood care. 

There is much to learn from innovative neighbourhood-based models that are already revitalising relationships between the public sector, voluntary and community organisations and citizens.  We know that in places like Lambeth, starting with culture has been key to their success. They invested time in getting to know their communities, building shared values and agreeing shared outcomes, before together reimagining the purpose of their health system and support for people with complex needs. 

We encourage NHS England to learn from the most mature places, but also ensure every place is able to engage and contribute to a reimagined shared purpose for neighbourhood health.  One that not only provides a clear ‘north star’ for collaborative efforts, but that also unlocks motivation, energy and creativity in even the most overstretched leaders, staff and members of the community.  

2. Realising agency through actionable learning 

The National Implementation Programme has the potential to significantly accelerate the spread and scale of already successful new models of neighbourhood health. But this will only succeed if it is designed as a learning system that realises the agency of local leaders and local communities. This means it must invest in understanding what new models have been developed, how change has been achieved, and why they really work. Moreover, the programme must realise the agency of local places and leaders by providing learning spaces, creative learning outputs and dedicated practical support to help new places apply this learning, bringing the practices, enablers and impacts to life in their own local contexts. 

Innovative neighbourhood health models are often celebrated as case studies but struggle to grow and spread to other places. Innovation Unit has developed a tried and tested approach to adoption and scale that has enabled whole systems like Greater Manchester, to spread community-led and multi-agency approaches that are disrupting traditional models of care.  

We work alongside innovators and adopters to understand which elements must be preserved to maintain effectiveness.  This fidelity approach surfaces the core principles that generate impact and frees up local partners to imagine, test and learn ‘how’ it can work in their context.

3. Growing power for communities, patients and carers 

Too often, innovative new models of care struggle because the current funding, accountability and governance systems are resistant to change. Faced with competing organisational priorities, resource constraints, rigid commissioning processes,  professional silos, and closed data systems, it’s no surprise we’ve seen so little change despite decades of policy commitment to prevention, integration and community. 

NHS England and central government must work harder to create a policy environment that makes it easier for neighbourhood health models to grow and scale. This will inevitably include growing the power of communities, patients and carers by shifting governance, accountability and control of resources closer to local communities, and away from Whitehall, as well as thoughtful change to existing performance frameworks, regulations, financial and workforce incentives. 

Even with this, we know that change is hard. It is likely that dedicated support will be needed to develop culture, capabilities and feedback loops between every level of the system – neighbourhood, place, Integrated Care Board and national. This support can help foster: 

• Joined-up leadership – demonstrating the compassion, courage and humility needed to take people on a journey toward better services and systems
• Collaborative spaces – dissolving existing power dynamics and bringing together multiple marginalised voices alongside staff from across sectors and different levels of the system
• Communities of practice – allowing teams to test, learn, and implement new ways of working, grounded in evaluation data and person-centred insights 
• Effective joint governance – enabling, rather than stifling, innovation, and managing risk while creating space for experimentation.

4. Creating a coherent roadmap for whole-system change 

Large scale reforms in health and social care often fail because there is either too much prescription (leading to a lack of local ownership) or too little structure (leading to uncertainty and inconsistency).  

Our research on large-scale transformation has shown that new ideas are successfully scaled when there is a coherent plan that provides:

• evidence, relationships and networks that build demand 
• sustained narratives that communicate the ‘why’ and the ‘how’ 
• expert support to places that balances fidelity, quality and adaptability 
• thoughtful (re)alignment of policy, financial and commissioning incentives 

Policy-makers regularly underestimate the time, leadership and infrastructure it needs to create long-term sustainable change. We are encouraged to see that the Neighbourhood Health Guidelines  acknowledge that it will take 5-10 years to grow the effective partnerships needed to shift to a genuine neighbourhood model of health. 

The National Implementation programme has the opportunity, and responsibility, to learn what is enabling progress and what is getting in the way, at every level – neighbourhood, place, and system.  It should explore what makes the biggest difference to local people and local systems, and use this learning to inform the national plan, focusing on:

• how NHS, local authority, and the community will be involved in decisions
• how progress will be measured in ways that build local ownership and use of evidence
• how learning will be used to inform priorities, change accountabilities and shift resources over time. 

A real system shift 

We have walked alongside many local systems, helping them grow new cultures, realise agency, and embed new structures and capabilities, generating the power needed to unblock systemic barriers, address immediate needs, and create courageous new models and practice.  

We are excited about what can be achieved with the support of a coordinated national and local implementation programme. And we’re optimistic that with the right vision, learning, planning and support, it will be possible to shift our current system towards prevention, community and equity.

If you would like to find out more about Innovation Unit, our work with neighbourhoods and places,  and how we could support you, Contact Christina