Neighbourhood health is gaining energy and support across health and care systems following the launch of the 10 Year Health Plan. All three ‘shifts’ set out in the plan – hospital to community, sickness to prevention, analogue to digital – could come to life through neighbourhood working. The focus on cross-system team-work, community connection and gaining insights from data, all give hope that new forms of public service delivery can become a reality. But in the midst of so much change, it’s crucial that we use and build on what we already know about collaborative, localised working so we can accelerate the pace and impact of change.
Drawing on our work with NHS England to develop frameworks and resources to tackle health inequalities, we’ve outlined four themes to help neighbourhood teams navigate health inequalities and plan effective interventions.
Community-led, hyper-local focus
The localised population health focus of neighbourhood health provides an ideal scale to improve equity of access, experience and outcomes of care for patients. It allows for connections and relationships of trust to develop across different partners that is not realistic at a greater size. Reducing health inequalities and improving overall population health locally are not ancillary goals for neighbourhoods, but central to their mission; doing so at neighbourhood level enables a much more tailored approach, with localised solutions tackling what can be very different challenges within a relatively small geography.
In our experience, working closely with local voluntary, community, faith-based organisations and social enterprises is vital in addressing unmet need and improving health equity. These groups know, work with and for local people, and are rooted in their locality. But these partnerships need to be based on equality and respect, recognising the value and funding needs of community organisations.
As a sector, we have become adept at engaging with communities to help understand issues and design solutions, but that can often be where the real involvement ends. Community-centred approaches benefit significantly from VCFSE partners being directly involved in delivery, with the funding to do so effectively. This not only builds on the existing trust these organisations have within their communities, but also provides a valuable source of income to help maintain their work while addressing specific priorities on behalf of health and social care organisations.
People more than buildings
While improvements to primary and community estate are vital, and long-overdue, we need to balance a focus on buildings with further investment in relationships, integrated team-working, digital connections and shared processes.
The Government announced a target of 120 Neighbourhood Health Centres to be operational by 2030 but for many footprints, particularly in rural areas, we will need to go further to provide the local presence and accessibility needed to realise the three shifts and improve health equity. For example, enabling effective patient records-sharing for team members across different organisations (primary care, community trust, social care etc) will enable case-management for proactive care. This will have greater benefit and impact in delivering more seamless and targeted care for local patients and communities, particularly more excluded groups, than updated health centres. The challenge here is for neighbourhoods – and commissioners – to balance investments in physical, digital and workforce infrastructure to maximise the impact from limited resources.
Learning from evidence and experience
Although the Neighbourhood Health Implementation Programme is new, many of the underlying concepts are well established. Each area will need to crystallise its own delivery approach to meet local population need and organisational landscape, but there is a huge body of evidence and experience to learn from.
The CORE20PLUS5 initiative, for example, incorporated a programme of community involvement and enabled direct intervention supporting the most deprived 20% of the population, providing a practical model to target health inequalities through high impact interventions. Inclusion frameworks, such as the digital inclusion and community languages frameworks, provide a wealth of guidance and support to help neighbourhoods plan strategies to improve equity. The EQUALISE and FAIRSTEPS toolkits based on academic research help primary care identify unequal access to their services and co-design solutions within their communities. In addition, the pre-pandemic guidance from Public Health England on place-based approaches for reducing health inequalities is particularly relevant to neighbourood health.
Insights from data
Neighbourhood health teams will benefit if they are able to work directly with data analysts, rather than relying solely on dashboards and reports for local interpretation. Local footprint analysis gives neighbourhoods a picture of current and projected health needs, wider determinants of health (e.g. on housing, employment, income), the local environment and transport links.
Working in partnership with ICB, public health or inhouse analysts can help teams formulate and explore key questions about local patterns of demand, evidence of unmet need, variation and health inequalities. Taking a data-enabled approach at neighbourhood level will connect into the wider ICB analysis and support strategic commissioning across a much wider geography.
Expectations for neighbourhood health are high. Despite the current context of major organisational change, the potential for a genuinely responsive, adaptive and engaged model of local health and care across organisational boundaries and with communities provides a solid basis for improving population health and equity.
