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Local Trust is marking the start of a new partnership with the NHS Confederation, which will explore the importance of community-led health in the Big Local programme and the need for radical transformation when it comes to health and care in the UK.

Spring 2024 marks the start of a new partnership between Local Trust and the NHS Confederation – a membership organisation which brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland, working with its members to drive forward integration and partnership working in healthcare.

The partnership’s central aim is to improve population health and reduce inequalities through joined up, community-led approaches at a hyper-local level. This will be achieved through the creation of practical partnerships between Big Local areas and NHS partners, and building a community of local leaders to share learning and drive change.

Through the partnership, new evidence on the conditions for successful integrated approaches will be disseminated, with the goal of influencing systemic changes to health and care at a national and system level.

The partnership will also build on learning from Big Local, where neighbourhoods benefitting from the programme’s long-term funding, devolved decision-making and flexible capacity-building support have made positive changes to the way health and care is delivered for and experienced by local people.

Examples include:

  • Ewanrigg Big Local in Maryport, Cumberland, where high levels of deprivation had led to growing concerns about poor mental and physical health. In response, the Big Local area introduced their ‘Hug a Mug’ initiative, to provide local people with somewhere to meet and connect with others over a warm drink and to chat to trained volunteers. A group of local organisations renovated a physical space for the project to take place in, with a GP practice in the area also lending its support.
  • Cornwall’s Par Bay Big Local and their ‘Cornubia’ community hub, which provides activities combatting poor health and social isolation.
  • Bradley Big Local, in Lancashire and their range of activities, including football summer camps and a community garden, which encourage people to connect and form healthy lifestyle habits together.

These hyper-local interventions come at a time when those living in the wealthiest parts of the country are currently outliving those in the poorest areas by more than eight years.

They also follow seismic events, including the COVID-19 pandemic, as well as decades of cuts to investment in services, which have lowered living standards and fractured community connectedness. This has negatively impacted our health as a country – with the most severe impact being felt in places where poverty is most deep-seated.

Local Trust’s partnership with the NHS Confederation is born out of previous work calling for the need to focus on community approaches to health and wellbeing, including Professor Claire Fuller’s report into integrated primary care, in which she recommended establishing Integrated Neighbourhood Teams.

Demos’ 2023 report The Preventative State, written in partnership with Local Trust, examines the idea that we are stuck in a ‘doom loop’ of surging demand for services, including health and social care, and that we have a state and system that’s in constant firefighting mode.

And a report from New Local and Local Trust published last year, Well-Placed: The impact of Big Local on the health of communities, asks whether communities can prevent illness and create their own good health, exploring whether investment at grassroots level could help ease the burden on the NHS.

Through the new partnership, Local Trust and the NHS Confederation will build on this work, to provide critical learnings at a time when new ideas are vital to make the country’s health system fit for the future.


We’re tendering for a two-part foundational research project into the current state of integrated, community-led working within the UK. This will include international examples of joined-up approaches to reducing health inequalities at a hyper-local level. To find out more, visit the NHS Confederation website.