A Neighbourhood Health Service: Community sector reflections on the NHS 10 Year Plan

The NHS 10 Year Plan’s commitment to delivering more care in the community is a welcome step. However, to fully realise its potential, it should be underpinned by stronger partnerships with local community organisations, support for primary prevention, and targeted funding for the areas with greatest inequalities

It’s been five weeks since the NHS 10 Year Plan was launched. Now the stream of initial reactions has ebbed, we’ve partnered with Locality to reflect on what it means for communities and whether it is enough to deliver the change they need and deserve.  

The government’s ‘overall ambition’ is to halve the healthy life expectancy gap between the richest and poorest regions. The Plan sets out three shifts to achieve this: shifting care from hospitals into the community, shifting from treating sickness to preventing it, and shifting from analogue to digital. 

Our history working directly with communities experiencing the greatest health inequalities shows us that the NHS can’t go at it alone to stop preventable, generational ill-health. If delivered effectively, the proposals set out in the Plan will improve the health service, but more needs to be done to develop true partnership between the NHS and the neighbourhoods and communities it serves.  

The shift to neighbourhood

The introduction of Neighbourhood Health Centres (NHCs) is the major proposal for providing more support in neighbourhoods and will be rolled out in areas with the greatest health inequalities first.  

We welcome the proposal to put healthcare under the same roof as employment support and debt advice, addressing some of the wider determinants of health. But NHCs are an opportunity to go even further: they could offer a truly neighbourhood-based service, co-designed with communities, that provides clinical care but reaches beyond it.

This could be achieved by embracing co-location with the full range of voluntary sector services that protect health. Activities and services provided by community anchor organisations, for example, have been found to address 91 per cent of the social and economic determinants of health.   

How this works in practice

The Plan refers to “repurposing poorly used, existing NHS and public sector estate” to create NHCs. One step further would be basing these in community-led and owned spaces, which local people often access and trust more than clinical ones. Transferring local health assets into community hands could unlock latent potential for community-led health creation – something the Fuller Stocktake recommended for the future of primary care back in 2022.  

For example, in Par Bay, Cornwall, Big Local funding helped residents take on the Cornubia community hub – a trusted space offering a range of social activities including walks, youth sessions, and support for isolated residents. Its proximity to the community attracted NHS investment, with diagnostic clinics and social prescribing now delivered on-site. And in Sunderland, Back on the Map has taken on the lease of the Ashburn Medical Centre to turn it into a Health Hub, combining clinical services with fitness classes and support groups in a direct partnership between voluntary and public sector organisations. 

Cornubia Community Hub. Photo credit: Charlotte Sams

A second proposal in the shift to neighbourhood health is the introduction of Community Health and Wellbeing Workers (‘CHEWIES’). CHEWIES will support direct engagement with communities on health, rebuilding trust and helping to make the NHS more responsive to grassroots need.

To build on local ties and assets, the deployment of CHEWIES in neighbourhoods should be led by community organisations who know, understand and are trusted by local people. This will make sure that lessons we’ve learnt from community organisations and Big Local areas across the country –  like aligning statutory services with community-led initiatives – are harnessed, not wasted.  

The shift to prevention

We know that shifting to a preventative health system is a long-term project. The Plan’s initial focus on secondary prevention like cancer screening and diabetes interventions will relieve cost and pressure on the NHS further upstream. But we are still waiting for practical proposals on primary prevention – addressing the causes of sickness in the first place – that truly deliver on the government’s commitment to reduce preventable, long-term sickness that the most disadvantaged areas suffer from most.  

The communities we work with have shown us that a meaningful shift to prevention will need the NHS to work in tandem with an ecosystem of local groups and organisations. They’ve shown us that good health is often created not in hospitals, GP surgeries or health centres, but in the community centres, green spaces, and social connections of the neighbourhoods in which people live.

Leveraging community spaces for neighbourhood health

Indeed, the Plan shows that the government has learned the lesson from COVID-19 that community organisations are vital to driving vaccinations uptake, but not the broader lesson that they are key to engaging local people in wider health messaging and activity. 

The experience of 150 Big Local areas has shown us that community-led social prescribing works: connecting local people to non-medical activities – like arts groups, social activities, exercise classes and financial advice – supports them to adopt positive health behaviours and manage conditions in community. But direct funding for community organisations to sustain socially prescribed activities is crucial. 

We hope that the Plan is one piece of a wider cross-government strategy on developing the infrastructure to improve population health and combat inequalities in every neighbourhood. The potential strength of Labour’s mission-led approach to government is its ability to unblock silos and align resource and commitment to deliver on population health.

The opportunity to align government departments in pursuit of reversing the trend of widening health disparities remains. We suggest this could start by pooling cross-government capacity and resource – including a five per cent shift in health budgets – toward community-led, primary prevention and health creation, addressing the wider determinants of health at the neighbourhood level.

Funding for the most health unequal areas

Additional funding for the most disadvantaged areas is welcome – an important first step in acknowledging the resource and capacity they need to develop long term, locally-led solutions to health challenges. Research on what makes area-based initiatives successful suggests that getting to the root of health inequalities requires neighbourhood-level intervention – covering populations of roughly 8-10,000 people.  

We suggest that the funding is targeted specifically at those neighbourhoods which, as things stand, are struggling the most. Sometimes referred to as facing a ‘double disadvantage’, they are both the poorest parts of the country which also have the least community infrastructure.

These neighbourhoods already have worse health outcomes and higher prevalence of preventable health conditions like lung disease and some cancers than other similarly deprived areas which have a healthy foundation of community infrastructure. They lack the community organisations and civic activity necessary to collaborate with the health system and deliver preventative community initiatives.  

The additional funding should support the development and growth of the local VCSE organisations in these neighbourhoods, supporting and building trusted, holistic, person-centred support as part of hospital discharge pathways, community support for frequent A&E attendees, and general illness prevention and health creation services.

As the Plan sets out a change in the role of Integrated Care Boards to become “strategic commissioners” of such services, there should be alignment with the government’s emphasis of the commissioning of local VCSE organisations to make the most of expert local knowledge and invest in local economies. 

A solid base, but further to go on ambitions for healthier neighbourhoods and communities

In all, the Plan’s direction is hopeful, but a clear roadmap for how we get to a “new model of care, fit for the future” is missing. While we’re pleased at the vision, communities will be left wondering what the practical steps to delivering a neighbourhood, preventative healthcare will mean for them – and what their role will be in making it happen.  

For more information, find our joint submission to the NHS 10-year Plan consultation on Locality’s website.