The essential role of communities in a neighbourhood health service

As the government looks to build a neighbourhood health service centred on prevention and place, communities have an essential role to play in improving health and wellbeing. In this blog, our policy and data analyst, Kyle Vanelli, reflects on discussions at NHS ConfedExpo and why communities are vital to building a neighbourhood health service.

Up and down the country, community networks and organisations are often the first line of support for people facing social, financial, or emotional pressures. They extend the reach of formal services, mobilise quickly, work with fewer restrictions, and support people earlier. In doing so, they can help prevent problems from escalating and reduce the number of people reaching crisis point – freeing up clinical services to respond where they are most needed.

But to make the most of this support, we need to move away from a paternalistic model in which people are seen only as patients or service users, and towards one that recognises residents and communities as partners in creating health. The responsibility for healthier places cannot sit with communities or the NHS alone. It must be shared.

Recognising and resourcing the essential role of communities

This was brought into sharp focus at the annual NHS ConfedExpo conference, which brings together over 7,000 attendees from across the health and social care sector. Alongside clinicians, doctors, and policy leaders, the conference spotlighted the essential work happening in communities to keep people healthy in everyday life.

To highlight our action research programme with NHS Alliance, we hosted a panel, “Communities taking the lead: what does it take to build equitable partnerships between communities and public sector?”. Beyond asking whether communities have a role to play in supporting good health, the panel focused on whether the health system is capable of recognising and resourcing the essential gaps communities already fill. It also sought to highlight the findings in our action research programme in partnership with NHS Alliance, which seeks to better connect community-led organisations with NHS services.

The NHS faces pressures that clinical services cannot solve alone. Growing inequalities, ageing populations, and the long-term effects of austerity all create pressure on the health system and the need to find a solution outside of clinical means. A shift from crisis response to prevention must start with the places, relationships, and assets that shape people’s daily lives.

The Expo panel drew from the Big Local programme to centre the impact communities have on the wider determinants of health. Speakers included Kate from The Centre in Ewanrigg, formerly Ewanrigg Big Local, and Yak from Lancaster CVS, a former member of the West End Morecambe Big Local.

Chair exercise activities taking place inside Stanleys Community Centre in West End Morecambe Big Local. Photo: Local Trust/Orrin Saint-Pierre

Communities as everyday health infrastructure

Across the panel, there was a recognition that voluntary, community and social enterprises often work in the spaces formal services struggle to reach. They are present in neighbourhoods, responsive to local needs, and trusted by people who may feel distant from public institutions.

This support is fundamental in disconnected areas like Ewanrigg. With residents facing severe deprivation and limited access to basic services, community organisations so often act as the link between people and the support they need. At The Centre, a community-owned building, weekly meals attract elderly locals who might not otherwise leave the house. The space offers modest, relational support, whether it’s working with the local GP or signposting grassroots services. Coffee mornings, chair yoga sessions, and Citizens Advice pop-ups all extend the reach of services which locals would otherwise struggle to access.

Working with communities is not just a route to better service design, but a means to build confidence, connection, and agency.”

Starting with people

Yak’s reflections from Morecambe and Lancaster CVS brought to life the importance of direct, trusted engagement with residents.

Morecambe is an area with severe poverty and inequality, suffering from poor-quality private rented housing, limited access to jobs, and a high demand for mental health services. In areas with such complex issues, the starting point cannot simply be a dataset or service pathway. Data is important, but it cannot replace being present in a community, listening to residents, and understanding how their issues are intertwined.

In this context, Lancaster CVS regularly connects with health, business, and community leaders to identify shared priorities. They train and support VCSE organisations to identify unmet needs and improve their ability to reach the communities they serve.

It is a model of convening often typified by community organisations: slow, relational, and structured around collaboration and power sharing. From Yak’s perspective, this is essential to building trust and engagement with local communities. Considering the national ambitions for a ‘neighbourhood health service’, health systems should pay close attention to the movement-building of organisations like Lancaster CVS.

If national ambitions for a neighbourhood health service are to be realised, the health system must start by valuing this infrastructure.”

Beyond consultation

The idea that the process of engagement is important speaks to a wider truth: working with communities is not just a route to better service design, but a means to build confidence, connection, and agency. It helps people define their own priorities and strengthens the relationships and networks that make change possible.

But for this to be meaningful, the health system needs to shift towards genuine power sharing. As Kate and Yak described, “co-production” too often means asking communities for feedback after decisions have already been made elsewhere. Even as the language changes, vital power imbalances remain. Community organisations are expected to translate their impact into system metrics and accept short-term funding while continuing to meet high levels of need with limited resources. And as systems cycle through various strategies and plans, local organisations are left to jump through new hoops to prove their impact.

Speakers acknowledged that voluntary, community and social enterprises (VCSEs) are increasingly being recognised for their contribution within the NHS. But recognition is not sufficient to sustain their essential support. Communities and the organisations that serve them need flexible, long-term funding that builds on what is already working.

Sharing responsibility for better outcomes

If the NHS is to become more preventative, local, and equitable, it cannot treat communities as a delivery arm. It must invest in the spaces, networks, and local organisations like The Centre and Lancaster CVS that help people live healthier lives. If national ambitions for a neighbourhood health service are to be realised, the health system must start by valuing this infrastructure.

Explore stories and articles on how communities are shaping neighbourhood health and wellbeing on our new website Learning from Big Local.