There can be no 'Neighbourhood Health' without local government

The idea of a Neighbourhood Health Service, as articulated in the NHS 10-year Plan, is one that instinctively appeals to professionals across public services. The challenge, however, is to move the idea of a Neighbourhood Health Service from theory into practice and to define how this can become more than the sum of its parts through deep and meaningful collaboration between key local public services, the VSCE sector and local people.

Through running two neighbourhood health simulations, and through participation in the National Neighbourhood Health Implementation Programme, we have explored what neighbourhood health might look like beyond policy papers and organisational charts in real places, with real constraints and real people. This was shaped both by leaders and practitioners across public services, and with meaningful interaction with patients and service users.

PPL ran two simulations in 2025; one in London in June and one national simulation in November.

You can view a short video of the simulation.
 

What we found was both encouraging and challenging."

Unsurprisingly, there is an immediate pull to treat neighbourhood health as an NHS programme. This is based upon an assumption that reform should be designed and led within health structures, with others contributing as partners in delivery. That instinct is understandable. Accountability in health is clear. Budgets are significant. The pressure to act is immediate.

However, the challenges neighbourhood health seeks to address rising demand, persistent inequality, avoidable crisis do not sit neatly within any one institution.They sit in place.
If neighbourhood health is to shift outcomes rather than rearrange services, it must be shaped accordingly. This won’t be effective without a real focus on developing genuinely collaborative solutions, based upon a shared vision and outcomes.

Designed for complexity, not simplicity

The core elements of our public service infrastructure were built for a different era; when problems were more contained and responsibilities more clearly separated. Health services treated illness. Councils delivered universal services, prioritising community well-being. Voluntary organisations didn’t just fill gaps in statutory provision but added value through local knowledge and endeavour. To a large degree, each operated with defined roles and vertical accountability.

Today’s reality is starkly different. Vulnerability overlaps. Inequality compounds. Families interact with multiple professionals in a single week and still feel that no one is holding the whole picture. Service silos always created issues and challenges but now they manifestly reinforce problems and hamper the delivery of services and outcomes.

In our simulations, progress did not come primarily from refining clinical pathways. It came when conversations shifted from organisational remit to shared responsibility for a neighbourhood.

When housing, public health, adult social care, primary care and community organisation stopped asking, 'where does this sit?' and began asking, 'what does this place need and how do we align around it?' Real change happened.

That shift is subtle in language, but significant in practice.

Why local government matters

Local government’s role in neighbourhood health is sometimes framed as supportive, bringing expertise in prevention, public health and community engagement. All of that is true. But it risks understating something more fundamental.

Councils are stewards and leaders of place."

Councils, through their members and officers, both know their people and places and crucially hold democratic legitimacy. They are accountable for housing, children’s services, social care, community development and many of the wider determinants that shape health outcomes, long before someone enters a clinical setting. They operate at a scale that connects strategy to street.

To treat neighbourhood health primarily as clinical integration is to focus on one part of a much wider system.

If prevention, inequality reduction and long-term resilience are serious objectives, they cannot be added later. They must be designed in from the start. That requires local government as an equal partner in shaping neighbourhood health.

Our experience is that both Health and Local Government understand this but don’t often enough, especially in the context of national guidance and frameworks, work collaboratively together to maximise the synergy and impact that the two key local public services can bring, when they work effectively together in place.

The challenge is to make local leadership and collaboration the norm.

Power, legitimacy and trust

Neighbourhood health will require more than organisational alignment. It will require leadership and legitimacy.

Local political and community leaders play a crucial role here. They shape how change is understood locally. They connect institutions to residents. They hold a public mandate and can humanise and legitimise a concept that can feel gimmicky and not rooted in the everyday experience of local people who are battling with a complex system of health and care.

In both simulations, momentum accelerated when resident participation moved beyond consultation, towards shared decision-making. When communities were not simply asked for feedback but invited into shaping priorities and solutions.

Councils often have the relationships and infrastructure to support that kind of engagement. Without it, neighbourhood health risks being experienced as something done to communities rather than with them.

Trust cannot be retrofitted. It must be built into design.

Human scale matters

The most meaningful impact we observed happened at a local level: on estates and high streets, in schools and GP practices, in conversations between professionals who knew and trusted one another and understood their place and community.

Neighbourhood health works when it reflects the reality of people’s daily lives."

Councils are uniquely placed to maximise opportunities here they can connect services across neighbourhoods, convene local partners and understand how policy can be translated into real improvements in outcomes.

Crucially, this is about real partnership and collaboration, both between health and local government and local organisations and residents. If neighbourhood health becomes overly defined by structures and governance, it risks losing the factors that gives it the opportunity to deliver real change. For neighbourhood health to be effective it must be based on relationships not traditional hierarchies.

A narrow window for change

There is, we believe, a limited window to shape neighbourhood health as a genuinely collaborative and shared endeavour.

If it settles too quickly into established patterns and is driven by a focus only on national guidance, designed within one system and delivered with others, the broader opportunity may narrow. Structures will solidify. Roles will harden. Ambition may remain high, but scope for deeper change may shrink.

Conversely, if councils, the NHS, VCFSE partners and communities shape neighbourhood health together from the outset, it can become more than a service model. It can become a practical demonstration of how public services organise differently around people and place.

This will require maturity and realism. Budgets are not equal. Accountability frameworks differ. Pressures are intense. But collaboration that avoids difficult conversations about power and responsibility is unlikely to produce lasting change.

From programme to transformation

Neighbourhood health is not simply about integrating services more tightly:

• It is about organising around place rather than institution.
• It is about embedding prevention, rather than retrofitting it.
• It is about sharing accountability for outcomes that no single agency controls.
• It is about ensuring that resident voices shape decisions, not just communication.
• Local government’s role as a collaborative leader is crucial to success.

Without democratic legitimacy, stewardship of place and influence over the wider determinants of health, neighbourhood health risks becoming a more joined up health service, not a comprehensive well-being service enhancing the quality of life of local people.

The challenges we face are not the result of failure in any single institution. They reflect the way those institutions have evolved separately over time. Neighbourhood health offers a chance to align them differently.

Sean Harriss
Senior Adviser, PPL