Building healthy neighbourhoods through community action

Local Trust’s policy officer, Kyle Vanelli, reflects on our health sprint event held earlier this year, in partnership with the NHS Confederation and PPL. With discussions centring around our struggling health system, Kyle outlines the key changes needed for a new approach to building healthy neighbourhoods and how we can learn from existing community models. 

In a small community space in Battersea, Duncan sits with a group of peers, sharing stories over tea. Just a few years ago, he was struggling with profound isolation after losing multiple close friends. Today, he’s an active member of the Battersea Befriending Network (BBN). BBN offers befriending to individuals suffering from mental health challenges and isolation, complementing the care of formal health services in the area. Duncan emphasises how important these social bonds have become, restoring his sense of connection and confidence. 

BBN is one of 30 community groups supported by Battersea Alliance, a local partnership of VCSE organisations, which emerged from Battersea Big Local. It has invested over £600,000 in the past five years into funding community activities that address isolation, loneliness, and mental health issues. Its approach is deceptively simple: build stronger social connections between people and prevent health problems before they require medical intervention.

Working in an area with significant inequalities, Battersea Alliance has developed a model that delivers remarkable value, with a recent analysis suggesting that every £1 invested creates £5 worth of health-related benefits for the community. 

The shift to neighbourhood working 

The government has pledged to transform the NHS into a ‘neighbourhood health service’ that shifts resources and responsibility to local communities and fosters approaches similar to that modelled by Battersea Alliance. But how might this be achieved – what needs to change in the NHS to enable it? In February, we brought together healthcare and community leaders for a two-day event – in partnership with the NHS Confederation and PPL – to consider this question. A full summary of these conversations is now available on the NHS Confederation website.

Everyone was clear on the context. A health system that is struggling to cope with ever-rising demand – with waiting lists, corridor care and the widening of health inequalities causing increasing concern, an ageing population, and public expectations exceeding the system’s ability to deliver. They were also clear that the traditional model, focused on treating rather than preventing illness, isn’t working. With these issues and limited public funding, participants agreed we need a new approach that builds on the assets and activities in communities to promote good health in everyday life. 

Our discussions identified several obstacles. One is how the NHS measures success. Its current focus is on outputs – how many patients are seen and the length of waiting lists – rather than outcomes which measure whether people are getting healthier. This short-term view discourages investment in preventative approaches that could improve health outcomes but don’t deliver immediate reductions in waiting lists.  

Another is the relationship between the NHS and communities. Local community services that help keep people healthy have seen their funding repeatedly cut over the past decade, especially in the poorest areas. When funding does reach community projects, it typically comes with strict conditions and short timeframes – making long-term planning difficult. The result is a healthcare system that focuses on “fixing bodies rather than seeing patients as whole people”, with little capacity to invest in preventing illness in the first place. 

We can continue down the current path of crisis management and widening inequality, or embrace a transformation that puts communities at the heart of creating health.

A new approach to building healthy neighbourhoods 

Participants at the event identified the key changes needed to create an effective neighbourhood health system. The first is to measure success by improvements in health outcomes, like years of life in good health, rather than outputs. This change would create incentives to fund preventative work that addresses health problems at their source, and force health systems to address the wider determinants of health through collaboration with public service providers and communities themselves. 

Another key shift is pushing health budgets down to place-level, which often align with local authority boundaries. As one participant noted, “We can’t wait until trust develops naturally: trust will follow the shift of resources”. Budgets held closer to home, together with analysis of neighbourhood level health data, would provide healthcare workers with greater flexibility to respond to local health inequalities and refocus the model on promoting good health in everyday life.  

The choice before us is clear. We can continue down the current path of crisis management and widening inequality, or embrace a transformation that puts communities at the heart of creating health. The evidence from Battersea and beyond suggests the latter is more effective, sustainable, and ultimately essential for the future of our NHS. 

Read more about the policy sprint’s findings in the NHS Confederation’s report, Resetting the relationship: towards a social model of health creation and care.