Neighbourhood health has moved to the centre of health and care policy. With the new Neighbourhood Health Framework requiring the NHS and Local Authorities to work much closely together. On the surface, the NHS and local government appear to be moving in the same direction. Both talk about prevention, partnership, place, and reducing health inequalities.
In practice, they have two very different approaches to the way they view health and conduct their work. In order for us to work much closer together we really need to understand how the two different systems think and work and measure success. Developing a deeper understanding of each other will make it much easier to build realistic partnerships and avoid the repeated failures that have characterised joint working in the past.
Table of Contents
Introduction
Neighbourhood Health represents a vital shift toward local, integrated, and preventative healthcare. With the goal to deliver care directly within communities, it promises a future where health services are not only more accessible, but more personalised and effective. The Neighbourhood Health Framework: portrays a patient/person centred model of health and care, with diverse range of services working together, so they can work together to serve their population. Including GPs and community services, diagnostic and urgent care services. Whilst also including local authority commissioned services, such as adult and children’s social care and public health.
However, whilst previous attempts at integrated working across the NHS and local government often produce success pilots and good initial progress, as time goes on progress has dwindled and often failed. As differences in goals ways of working, systems, funding and commitment has varied between services. This has happened time and time again and in particular failing of Torbay after more than 20 years, with and acrimonious split between services should be a lesson to us all.
If you would like to learn more about the what and why and key challenges of neighbourhood health please read this post. A big part of the reason neighbourhood has struggled that local authorities and the NHS have taken different approaches to neighbourhood health. None more so than currently with Local Authorities and the NHS each implementing separate initiatives on neighbourhood health at the same time. This article looks at the differences in the two different approaches so that we can learn to build partnerships, understanding and bring them together.
Two Different Plans for 2 different new Neighbourhood Health initiatives
The NHS Approach To Neighbourhood Health: Key Planning Documents.
NHS 10 Year Plan
The NHS approach to neighbourhood health has been set out through The 10 Year Health Plan for England (published July 2025) commits explicitly to creating a neighbourhood health service, with care organised around local populations rather than institutions, and a shift away from hospital-centred models towards prevention and community-based support.
Neighbourhood Health Guideline 25/26
You can better understand the initial intentions behind neighbourhood health through NHS England’s Neighbourhood Health Guidelines 2025/26, which describe neighbourhood-level multidisciplinary teams, population health management, and more proactive, coordinated care for people at highest risk. These plans position neighbourhood health primarily as a service delivery reform, focused on reducing avoidable demand, improving outcomes, and managing pressure within the health system.
Neighbourhood Health Framework 26
This model has been given much more detail and refinement in the recently published Neighbourhood Health Framework adds important clarity to how the NHS and local government are expected to work together at a neighbourhood level. (read an analysis here). The Neighbourhood Health Framework (2026) does not yet provide a clear implementation model. However, it does something important: it formalises expectations for how the NHS, local government and partners should align around populations, shared outcomes and joint delivery.
Fit For The Future: Towards Population Health Delivery Models.
Alongside the framework NHS has published a new commissioning guide for Integrated Care Boards called “Fit for the future: towards population health delivery models.” This is a guide for NHS commissioners: particularly ICBs on how population health will be commissioned and outlines the upcoming changes to services. (read a summary here)
Putting it Together
Whilst the framework and plans set an intention, and some details. The framework does not yet provide a fully realised model of delivery. Implementation remains vague, with limited detail on how these changes will be enacted in practice. Whilst the commissioning model require what appear to be radical changes in funding models and organisational structures. But whether these are actually deep changes or the little more than new icing on the cake is far from clear as there is a clear contradiction between keeping funding for existing organisations, and transitioning systems and processes through new contracts that are not remotely reconciled.
However, what it does do is set a clearer expectation of alignment between the NHS and Local Authorities. It signals that collaboration between the NHS and local authorities will increasingly be organised through shared geographies, shared planning, and more formalised delivery structures such as integrated neighbourhood teams and multi-neighbourhood providers with Health and Wellbeing Boards being a clear bridging mechanism. This shifts neighbourhood health from being a conceptual ambition to a clear direction with a more defined, though still far from complete, operating model.
The Local Authority Approach To Neighbourhood Health: Key Planning Documents.
Local government approaches to neighbourhood health are set out less as a single programme and more through place-based policy frameworks focused on reducing health inequalities and improving the conditions that shape health. Core national guidance includes the government’s Place-based approaches to reducing health inequalities, alongside long-standing policy and practice guidance from the Local Government Association. These documents frame neighbourhood health as part of a wider civic agenda, linking health outcomes to housing, environment, safety, economic security, and participation.
Rather than prescribing a standard model, they emphasise local leadership, neighbourhood-level decision making, and long-term change shaped with communities. In this context, neighbourhood health is treated as a place-shaping endeavour rather than a service redesign.
Are the NHS and local authorities solving the same problem?
At the level of diagnosis, there is genuine agreement.
Across NHS policy from NHS England and local government prevention strategies, there is shared recognition that:
- Health outcomes are shaped by where people live
- These patterns are long-standing and persistent
- National programmes applied evenly have not worked
- Change needs to happen closer to everyday life
That shared understanding matters. It represents real progress.
Where things begin to drift is when the focus shifts from what is wrong to what kind of change is actually being attempted.
What is NHS neighbourhood health actually designed to do?
NHS neighbourhood health treats inequality primarily as risk, deterioration, and demand for healthcare intervention. In most cases, it largely sidelines communities and wider social factors.
This sits within a broader strategic shift: moving care from hospital to community, from treatment to prevention, and from analogue to digital delivery.
The shift to neighbourhood health starts from a very practical concern: People are becoming unwell, often with multiple conditions, and the system reaches them too late. By the time support arrives, harm has already occurred, and services are overwhelmed.
The underlying belief is that poor outcomes and rising demand result from missed deterioration, fragmented care, and late intervention. Risk is understood mainly at the level of individuals and lifestyles.
As a result, the NHS focuses on:
- Identifying people at the highest clinical risk
- Acting before crises occur
- Joining up care around individuals
- Reducing avoidable admissions and harm
How this shows up in practice
- Risk stratification and population health tools
- Clinically led multidisciplinary teams
- Proactive reviews and care planning
- Tight operational rhythms
It’s Not What Neighbourhood Health Is, It’s What it Does That Matters?
Neighbourhood health can be understood not as a new structure, but as an attempt to shift the system towards a different pattern of organisations, one organised around place, relationships and population need rather than organisational boundaries. The real test must always be whether and how impacts people and communities. Not ticking government boxes or internal KPIS but whether the health system starts actually improving people’s health.
The Typical NHS Approach
NHS interventions tend to be tightly focused and data-led, with clear lines of clinical accountability and strong time pressure. Alignment with policies, procedures, and pathways is critical, including escalation criteria, referral rules, and clinical guidelines.
This model is designed for processing people, and therefore the NHS constantly emphasises productivity and efficiency. It is not designed to change the wider conditions that keep producing the same crises.
How is success defined in NHS neighbourhood health?
Success is largely framed through service and clinical performance.
Although there is an intended shift from measuring activity to measuring outcomes, it remains unclear how outcomes will be consistently defined and tracked. This will largely be determined by local ICBs as they move toward population health strategic commissioning.
The measures in the NHS Oversight Framework suggest outcome measures will focus on things like reducing hospital admissions, or diagnosis targets, rather than personal wellbeing.
What gets measured
- Emergency admissions and readmissions
- A&E attendances
- Length of stay
- Disease control indicators
- Activity against defined cohorts
- Outcomes (to be defined by local commissioners)
What success looks like
- Fewer crises among high-risk patients
- More stable long-term conditions
- Reduced avoidable hospital use
- Smoother flow through services
What is harder to see
- Trust between services and communities
- Relationships across organisations
- Patient experience
- Social determinants of health
- Long-term resilience
In practice, NHS neighbourhood health is judged by whether it prevents deterioration in people already close to the edge. It is also likely to focus heavily on specific disease areas linked to preventable conditions, such as diabetes, cardiovascular disease, COPD, and liver disease.
What the NHS Optimises For:
The NHS wants to define the most specific intervention with the most tightly defined group and with narrow outcomes to measure success. It wants to optimise for the smallest thing. This is to maximise controllability accountability and value for money. The more clearly and tightly the NHS can define everything (sometimes literally down to what words said to each patient) the better.
What is local authority neighbourhood health trying to change?
Local authority neighbourhood health takes a different starting point.
Here, inequality is understood as something produced by where people live. The focus is not individual risk, but the conditions that shape everyday life.
The belief is that people become unwell because of housing, insecurity, isolation, environment, and lack of opportunity over time. Whilst individual variation often disappears into averages. (The NHS does this at scale too!)
As a result, the emphasis is on:
- Whole neighbourhoods rather than selected individuals
- Everyday living conditions
- Civic participation and local power
- Long-term renewal
This leads to initiatives such as
- Neighbourhood-scale programmes
- Community hubs and shared spaces
- Housing, safety, access, and environmental action
- Co-production and local governance
The typical local authority approach
Local authorities work through planning, regulation, and local policy, such as housing standards or access to green space. They also commission lifestyle and prevention services, including smoking cessation, weight management, and drug and alcohol support.
Decision-making is often politically led and consensus-based. This can support collaboration across sectors, but it can also be slow, negotiated, and diluted to secure agreement.
How does local government judge success?
Success is framed through conditions, participation, and direction of travel rather than immediate outcomes.
What gets measured
- Neighbourhood-level indicators
- Participation and engagement
- Access to local assets and services
- Perceptions of safety and belonging
- Qualitative and narrative evidence
What success looks like
- Stronger social infrastructure
- Increased local participation
- Improved neighbourhood conditions
- Greater community capacity to act
What is harder to see
- Individual health trajectories
- Short-term service impact
- Attribution to a single programme
Local authority neighbourhood health is judged by whether the context that shapes health is shifting in a healthier direction. This has the benefit of allowing for more joined up interventions whilst allowing space and time for impact to occur.
However, the more holistic approach can often be at the expense of knowing what is working and how to improve upon it. It is often very hard to connect individual projects and actions with outcomes. (In my experience, this is a huge frustration in NHS organisations and managers who want to optimise everything)
What the Local Authorities Optimise For:
They want to optimise for the big picture. They want to look at the environment, risks of harm, probabilities and strategic opportunities, and listen to people’s views. They take a balanced broad spectrum view where people are able to live their lives unrestricted. Instead of a narrow clinical outcome, they seek balanced social outcomes, where risks are managed collectively, and strategic opportunities (like urban regeneration) create the conditions for people to live independently and unrestricted. They prioritise relational data (what people say they need) over purely transactional data (what the monitor says).
Do the different approaches complement one another?
In theory, yes there is a common direction, NHS neighbourhood health focuses on stabilising people whose health is already deteriorating. Local authority neighbourhood health focuses on reshaping the conditions that make poor health more likely in the first place.
When aligned well, place based work reduces the flow of people into high risk clinical pathways, while NHS neighbourhood services prevent those already at risk from tipping into crisis.
The problem is not complementarity. In theory both processes reinforce one another. With good environments and support preventing sickness but also helping recovery. Whilst people receiving good timely medical support are able to live healthier for longer.
Where the conflict occurs is actually over the focus of the work. The problems are more often are over where the attention goes, it is deciding what matters most, what to prioritise and what to do next.
The other common area of conflict is evaluating what works. With the NHS wanting evidence of targets and goals achieved and data around the cost effectiveness of specific interventions. Whilst local government wants to look at the big holistic picture and sees the constant measurement and evaluation of the NHS as creating lots of admin and obsession with counting. (Even if there is already a massive evidence based on an intervention such as smoking cessation). The NHS rarely asks what matters to people and communities and misses broader and long term impacts. This conflict over outcomes is often why integrated working is rarely sustained, especially in times of financial pressure.
It is important to mention that, Neighbourhood health is not a separate system alongside the NHS and local government. The Neighbourhood Health Framework clarifies that it is intended to be an integrating layer, reorganising how both systems operate around shared populations and places. But that means that is easy for the differences to be exaggerated over time, rather than reconciled within one organisation owning the problems and having the final decision.
The evolving role of Health and Wellbeing Boards
To reduce the potential for conflict, he Neighbourhood Health Framework explicitly recognises Health and Wellbeing Boards as part of the delivery architecture, reinforcing their role in aligning strategy, commissioning and outcomes across organisations. “This elevates their importance — but does not resolve their historical limitation: influence without direct control over delivery.”
While their formal role has not significantly changed, the expectations placed on the system around them have. The framework requires greater alignment between NHS organisations and local authorities, and Health and Wellbeing Boards remain one of the few structures where this joint accountability already exists.
This positions them as a potential integrator within the system, bringing together strategy, priorities, and oversight across organisational boundaries. Aligning strategy and tactics at a high level. The Neighbourhood Health Framework elevates their importance, but does not resolve their historical limitation: influence without direct control over delivery.
However, the effectiveness of this role is not guaranteed. Health and Wellbeing Boards have historically struggled to influence operational delivery, and without changes in authority, incentives, and capability, there is a risk that their role remains largely strategic rather than transformational. Whilst they may set a direction they still have to overcome the extraordinary pull of internal organisational politics.
What is the unit of change in neighbourhood health?
The NHS and local authorities define neighbourhoods very differently.
- NHS neighbourhood health typically works at populations of 30,000 to 50,000 people. This is the scale at which integrated neighbourhood teams become viable, bringing together pharmacists, mental health staff, physiotherapists, and others.
- Local authority neighbourhood health usually works at populations of 5,000 to 15,000 people. These align with schools, streets, parks, history, and democratic boundaries.
It is important to note that the boundaries of the NHS neighbourhoods may not coincide with local authority neighbourhoods. This means you can’t fit 3 or 4 LA neighbourhoods into an NHS neighbourhood. (As the NHS boundary can go right through the middle of an LA boundary.)
The two different definitions of neighbourhoods is already causing a lot of confusion amongst communities, local leaders and politicians.
These are usually separate initiatives, running at the same time, in the same places, involving some of the same people.
Alligning Around Places
Multi-Neighbourhood Providers (MNPs) are likely to become a key NHS delivery vehicle at place level, bringing together services across multiple neighbourhoods. This creates the potential to align more closely with local authority delivery mechanisms, which are already organised around place and population. Their scale and scope mean they have the potential to align more closely with local authority delivery mechanisms than traditional NHS organisational forms.
This creates an opportunity for more coherent place based working. However, this alignment is not automatic. These are still NHS organisations with NHS contracts. We also don’t know many details about who they will be. (GPs, community trusts, Acute Trusts) what their powers and responsibilities are. In practice however, this alignment depends on whether MNP boundaries, incentives and priorities are deliberately configured to match local government structures, something the framework does not yet guarantee.
Why the Joint Strategic Needs Assessment (JSNA) Becomes Critical
The Joint Strategic Needs Assessment (JSNA) becomes increasingly important in this context. It is one of the few genuinely shared documents between the NHS and local government, providing a common evidence base for understanding population need.
If neighbourhood health is to be genuinely population led, the JSNA should act as a central anchor, shaping priorities, resource allocation, and service design across both systems.
However, this represents a significant shift from how JSNAs are typically used today. In many areas, they remain descriptive documents, rather than active drivers of decision making.
The effectiveness of neighbourhood health will depend in part on whether the JSNA evolves into a live, operational tool that directly informs neighbourhood level delivery.
“This matters because neighbourhood health requires a shared understanding of population need across organisational boundaries. The JSNA is one of the few artefacts that already spans NHS and local government, making it a natural anchor for alignment.
However, the framework does not mandate how JSNAs should be used in decision making, leaving open the risk that they remain descriptive rather than operational
Where is there genuine agreement?
Despite the differences, there is a real consensus between the NHS and local authorities about the direction of change to neighbourhood health.
Both approaches accept that:
- Neighbourhoods matter
- Healthcare alone cannot reduce inequality
- Partnership is essential
- One-off projects do not work
- Local flexibility is necessary
Both also recognise, often quietly, that inequality is produced faster than any single programme can remove it.
A key shift within the framework makes is the move towards joint accountability between NHS organisations and local authorities, rather than parallel responsibility.
Why do joined-up approaches to neighbourhood health so often fail?
Failure is rarely about intent.The joined up approaches between local authorities in the uk often fail, because they are working with different focuses, with their organisations pulling them in different directions, meaning that compromise and agreement is difficult.
The NHS works with individuals and defined cohorts, focusing on process and performance. Whilst Local Authorities work with whole neighbourhoods, focusing on social and political priorities.
Each side often sees the other’s weaknesses as failure. Local authorities view NHS approaches as short-term and narrowly performance-driven. The NHS often sees local authority approaches as unfocused and hard to evidence.
When pressure rises, both systems retreat to what feels safest and pull funding to support their ‘core services’ often leaving communities bereft. Short-term progress is lost. Funding is often recycled through existing projects under new labels, resulting in little real change.
The history of collaboration between the NHS and local authorities is full of ups and downs to say the least. However, what we can say is that repeatedly over time the two parties have repeatedly been sucked back into their existing models. Particularly based on culture, finance, and bureaucratic processes. I explore the strong pull of these factors and neighbourhood health in detail in this article: How Can We Escape The Whirlpool & Make Neighbourhood Health A Success?
When both talk about prevention, do they mean the same thing?
The Local Authorities and the NHS use the same word, but they mean different things with prevention.
- NHS prevention focuses on preventing deterioration and detecting problems in people already known to services.
- Local authority prevention focuses on reducing exposure to harm before people become patients.
Both matter. They sit at different points in the causal chain, but rarely are they designed to reinforce one another across that chain.
Why do timelines, money, and accountability feel so misaligned?
Because they are.
Local authorities operate under democratic accountability and political judgement. They expect slow change and consensus.
The NHS operates under strict financial and clinical governance, regulatory scrutiny, and short performance cycles. It needs rapid feedback and the ability to move money quickly.
Funding, measurement, and tolerance for uncertainty follow these logics. These are structural realities, not cultural failures.
What role do VCSE organisations play?
In NHS neighbourhood health, VCSE organisations are usually positioned as:
- Delivery partners, commissioned to provide specific services that sit alongside clinical pathways
- Referral destinations, particularly through social prescribing or care coordination routes
- Measured through outputs, such as numbers seen, sessions delivered, or referrals completed
In this model, VCSE organisations are valued for what they can deliver, but rarely for shaping the problem or setting priorities. Knowledge tends to sit with clinicians and system leaders, with community organisations positioned downstream of decisions already made.
In local authority neighbourhood health, they are more often:
- Co-designers, involved early in shaping neighbourhood priorities and responses
- Governance participants, contributing to neighbourhood boards, forums, or partnership structures
- Sources of legitimacy and insight, grounded in lived experience, trust, and long-standing relationships
Here, VCSE organisations help define what matters in a place, not just how services are delivered. Their value lies as much in sense-making and connection as in formal delivery.
Where does social care fit?
Social care sits at the centre of neighbourhood health, but is positioned differently in each system.
In NHS neighbourhood health, social care enables people to remain at home, supports discharge, and holds risk for people with complex needs. Its contribution is critical, but often invisible in NHS measures.
In local authority neighbourhood health, social care is formally part of place-based working. In practice, statutory duties and financial pressure mean it is often focused on crisis response rather than long-term change.
Across both, social care absorbs complexity that neither system can remove.
From Alignment on Paper to Harmony in Practice
The Neighbourhood Health Framework strengthens structural alignment between the NHS and local government. It introduces clearer expectations around shared planning, shared geographies, and coordinated delivery.
However, it remains largely silent on how this alignment will be achieved in practice.
There is a risk that alignment becomes something that exists on paper, through plans, frameworks, and governance structures, without translating into meaningful changes in how organisations work together day to day.
True neighbourhood health will depend not just on structures, but on relationships: trust between organisations, shared decision-making, the ability to jointly manage and fund processes and pathways and the ability to act collectively in response to local need.
The framework strengthens structural alignment, through shared planning, metrics and delivery expectations. But structural alignment does not guarantee functional alignment.
Without this, there is a danger that the framework becomes another layer of system architecture rather than a genuine shift in how health and wellbeing are created within communities.
The history of health and care reform suggests that shared structures can exist without meaningful changes in behaviour, decision making or power.
To move from Paper to Practice, requires leadership not just to take the initiative and get it started, but an ongoing basis proactively addressing problems and tensions. Working across organisations to keep work effective is a very different role from traditional management approaches that dominate in both the NHS local government organisations.
Successful partnerships between Local Government and The NHS
All of the above describes a pattern that has emerged over many years. It is not universal. There are places where local government and the NHS have partnered more successfully, not because they erased their differences, but because they worked with them.
- Wigan
Through what became known as the Wigan Deal, the council and NHS partners aligned around a shared commitment to community capacity, prevention, and relational working. The NHS focused on service coordination and clinical care, while the council invested heavily in neighbourhood infrastructure, voluntary action, and everyday support. Success came from long-term consistency rather than short-term programmes. (Le - Greater Manchester
Devolution created space for the NHS and local authorities to plan together at scale while still allowing local variation. Place-based teams brought together health, social care, housing, and VCSE partners, with councils leading on neighbourhood conditions and the NHS focusing on integrated services. Progress was uneven, but the direction of travel was shared and sustained. (read more here) - Leeds
Leeds has taken a neighbourhood approach that combines strong civic leadership with integrated health and care teams. Local government leadership on poverty, housing, and inclusion has sat alongside NHS neighbourhood services, with a deliberate emphasis on community voice and trusted relationships rather than constant structural change. - Barking and Dagenham
In Barking and Dagenham, neighbourhood working has been closely tied to regeneration and social policy, with the council leading on place and the NHS adapting services around changing community needs. Health improvement has been treated as inseparable from housing, employment, and local power.
Final thought
The Neighbourhood Health Framework does not resolve the long-standing challenges between the NHS and local government, but it does make the expectations clearer.
The question is no longer whether these systems should work together. In fact we know from history is that even if there are successfully intial flirtations over time they tend to grow increasingly apart.
We counter this we have to build strong reciprocal relationships. Bounded and strengthened by joint leadership, that brings the strengths of both to the table and mitigates their weaknesses. To do that requires a mutual appreciation, understanding and respect for on another. Combined with psychological safety and leadership that is able to identify and tackle where things are not working.
The test is is whether they can move from alignment in plans to harmony in practice, and neighbourhood health becomes a genuine shift in how care is delivered. Without that, neighbourhood health will continue to sound joined up in plans, while feeling fragmented on the ground. With patients falling through the gaps of competing and discordant systems.
Further Reading:
If you would like to learn more about neighbourhood health as well as understanding the challenges in implementation I explain more in this post.
I talk about the problems of resisting the pull back of our existing systems here to properly establish neighbourhood health.
Edge of PossibLe: Change, & Social Impact Consultancy For Health ORganisations
Empowering you to build effective community & neighbourhood health.
Building Better Health Together!
I offer personalised consultancy to help you and your organisation to help you make a bigger impact.
