What do the people creating Neighbourhood Health really think and believe?
There is no big implementation plan for Neighbourhood Health instead people have to find their own path. So understanding what those people shaping Neighbourhood Health believe is vital in understanding what matters and how we can best support them.
Table of Contents
Our Survey
In starting the Neighbourhood Health Academy it was really important to us to get a broader understanding of what people really think. So we could prioritise the things that matter: What do they believe are the biggest challenges and opportunities in Neighbourhood health.
This analysis is based on questionnaires filled in by the first 46 applications to the Neighbourhood Health Academy and what they are actually experiencing.
If you would like to apply to join the Neighbourhood Health Academy please apply here
1. People Are Joining To Create Something Different Together
It is inspiring that so many people were focused on Innovation. Neighbourhood health can’t be about following processes. It is about pushing the edges to understand and discover people’s needs and finding new ways to make a difference to people’s health.
If this innovation is to thrive we nurture and grow it and enable the real innovators to create paths for others to follow. It also shows that commissioning should not be too prescriptive.
With the NHS repeatedly criticised for being slow to adopt innovation here are people who are willing and able to take the lead and make it happen.
Connection was also high on the list and that shows the real strength in neighbourhood health is going to be created through relationships. Putting caring and learning about patients at the forefront. But it may create tension if the service is pushed to hit targets and KPIs and tick boxes, if it clashes with the people centred nature of the work.
People at the Innovative Edge of Change.
A core group of innovators is exactly what the theory of diffusion of innovation would predict. But what is exciting is that in this diffusion of innovation is a model where ideas are spread socially. So having innovators who are also passionate about social connection means that the ideas shared here are likely to travel far and wide.
Pioneers is probably the best description for this group of people. There is hunger and desire to shape the future of health. There is some frustration, yes. But there is also ambition in this people to make change happen
2. The Top Challenges Faced For Those Working In Neighbourhood Health
When we turn to the challenges, the emphasis shifts.
The biggest challenge that people name is alignment across organisations. Not the technical skills or capabilities for the job.
Neighbourhood health cuts across boundaries that were historically designed to separate responsibility and budgets. Our health and care system is deeply fragmented, divided by history and organisational politics. Neighbourhood health ambition is to close those gaps. But it is important to note that these divisions run deep. At the momen,t Local Authorities and the NHS are even completely at odds with what a neighbourhood is. (read about that here)
The key challenge of neighbourhood health is to align NHS services, primary care, local authorities and voluntary partners around shared population and purpose rather than individual contracts or institutional priorities. That shift inevitably creates tension.
The data suggests that people are not struggling to imagine what good could look like. They are struggling to create a shared narrative. To align incentives. To create clarity where governance is still evolving. To build trust across cultures that have grown up seeing each other as rivals.
The gap between services is both a challenge and an opportunity. It is an opportunity to lead, creating and delivering new forms of healthcare. Filling the gaps within the system and enabling services to flow around communities and patients. But it is also a challenge as we need to build trust and genuine collaboration across the system at all levels.
3. Top Goals For Those Working in Neighbourhoods
The top goals for neighbourhood health reinforce this picture:
Collaboration Is Both The Problem And The Goal. It is not surprising for a service that aims at weaving other services together that stronger collaboration ranked first. Whilst it is also embedded in the biggest challenges.
People are not aiming for marginal gains within the current system. They are trying to shift the underlying model, building a system of relationships that knits the system together. Moving from transactional care towards something relational and community centred. They want coherence a shared purpose, and to create new ways of operating at the neighbourhood level.
At the same time, there is a pragmatic realism here. Evaluation ranked third overall.
There is a clear awareness that neighbourhood health must demonstrate value in ways that are credible to commissioners and system leaders. Not just activity, but meaningful outcomes. With evidence that stands up to scrutiny.
Measuring Outcomes Sounds Easy, But is a Major Challenge.
Measurement of outcomes is a real challenge as the relationship between cause and effect is often complex and non-linear at the community level, with many factors lying outside of the control of health organisations. Whilst outcomes from better managed long term conditions can take months and years to impact ‘outcomes’. Very often, the timescales of budgets and reporting cycles of our healthcare system mismatch the timescales of people’s lives.
It is really important, therefore, that neighbourhood health workers work together with commissioners to develop ways to accurately and fairly capture the impact of their work. As well as aligning with the needs of the wider system. It will be a core goal of the Neighbourhood Health Academy to help people align with commissioner specifications and improve the outcomes of the people they work with.
It is also very likely that new technology opens the doors to fresh insights into people’s health as it is experienced in the community. Well, outside of the traditional KPIs of healthcare. There needs to be a whole new understanding of how we can learn to take advantage of the opportunity technology creates, such as wearable and ambient technology. We will be able to learn about people struggling well before it turns into an emergency, or even a long term condition.
4. A Cross Sector Cohort Of Applicants
It is great to see that applications came from a broad range of organisations and roles, spanning clinical, commissioning and community perspectives .
That diversity is vital to keep things fresh dynamic and overcome bias.Neighbourhood health cannot be built from a single professional lens. It requires shared understanding across clinical and community worlds, and the ability to translate between them.
There is, however, one noticeable gap. Primary care representation at the moment is less that a would like. No doubt because primary care are often so busy. This is why I’m keen that the community allows people to engage at multiple times and in multiple ways.
This is why I’m delighted that Dr Kiran Cheedella, a practicing GP, is a co-founder of the Academy so primary care input will be embedded throughout our work to ensure there is a good fit with primary care.
Given the central role of general practice in governance, contracts, clinical pathways and duty of care, this is important. If neighbourhood health is to work as a functional part of the health system rather than peripheral, primary care has to be at the heart of it, not adjacent to it.
4. Health Inequalities Are A Big Priority
Many applicants referenced:
- Stark inequalities
- Variation Within Neighbourhoods
- Access barriers
- Prevention gaps
In their application a large number of people mentioned addressing the problems of health inequalities in their area. A key role of neighbourhood and health within the wider health system will be to take the lead in addressing these embedded issues.
NHS initiatives have rarely been able to address these inequalities (and not infrequently increased them) as ‘The inverse care law’ means that implementation of healthcare initiatives such as reducing diabetes prevalence often struggles most in our poorest areas. (NHS England)
Health inequalities are often the result of a complex range of interactions socio-economic and environmental factors that create a unique ‘witches brew’ of problems in so many areas, that mean they are best understood and addressed locally not nationally.
In turn this means neighbourhood health must adapt to reflect the unique challenges of health inequalities in their area. Whilst building on local strengths, not just focusing on local deficits. Approaches such as asset based community development (ABCD), which put adapting to the strengths and needs of local communities at their heart, are rare in the NHS, but common in local authorities and there is much we can learn
Another major challenge is sizing with the NHS defining neighbourhoods as 30-50,000 people which has been widely criticised for being too big to feel natural to local people. This creates enormous practical challenges in some places with some neighbourhood covering large geographies or very mixed demographics, which frankly undermines the whole concept. However, there are a real practical issue that some of those working in neighbourhood health have to manage.
The Most Compelling Insight
What stands out is the ambition of those applying to the Academy. They are working at the unstable edge of a system in transition, trying to build neighbourhood health models within structures focused on organisational targets rather than outcomes.
They cross boundaries that were never designed to meet, translating community realities into commissioner language while holding clinical credibility alongside social context. By connecting and learning together, we can move beyond fragmented initiatives. The Neighbourhood Health Academy exists to support this work, helping systems learn how to deliver neighbourhood health well rather than repeat past mistakes.
What shines through in the data is the ambition people applying for the academy have for neighbourhood health. They are operating at the unstable edge of a system in transition, attempting to build neighbourhood health models inside structures optimised for organisational targets, rather than health outcomes.
They are working across boundaries that were never designed to meet, translating community realities into commissioner language, and trying to hold clinical credibility alongside social context. By connecting and working together we can move beyond fragmented initiatives. The Neighbourhood Health Academy, aims to offer support people working in this field to learn and grow together. To enable healthcare systems learn to get neighbourhood health right, rather than simply repeat the mistakes of the past.
Conclusion.
The people shaping neighbourhood health are led by innovation and trying to build a more relational, locally responsive, outcome focused model of care within a system still organised around institutional boundaries and performance targets. They understand that the hardest work is not writing strategies, but aligning incentives, building trust, generating credible evidence and building trust and collaboration between organisations.
There are many key challenges to overcome in building neighbourhood health, but the people taking part are hungry for innovation and change and want to build better relationships so that we can have an ever bigger impact on our communities.
If you are working at that edge, navigating complexity, trying to translate community realities into system language while holding onto what matters, then you are not alone. The Neighbourhood Health Academy exists to support exactly this work. If you want to shape neighbourhood health rather than simply react to it, we would welcome your application.
If you would like to join the Neighbourhood Health Academy apply 👉 HERE 👈.
Or you can learn more here.
