Supporting NHS Strategic Commissioning and Neighbourhood Health

This guidance explains how local authority public health teams can support new developments in the NHS following publication of Fit for the Future: 10 Year Health Plan for England. It provides a specific focus on public health support to the Strategic Commissioning function of Integrated Care Boards and the implementation of Neighbourhood Health.

It links this to the emerging role of ICBs as strategic commissioners, describing strategic commissioning as a continuous, evidence-based cycle of understanding population need, developing long-term strategy, allocating resources, and evaluating impact to improve population health and equity.

The guidance argues that public health teams are uniquely placed to bridge the gap between NHS, local government and community partners. As such, they occupy a unique strategic position, which can be reinforced through clear roles, sustainable governance, and appropriate data access.

The document sets out three practical contribution domains: insight and intelligence, health improvement and community development. The exact nature and extent of the support provided will be defined locally according to need and capacity. If properly harnessed by NHS bodies, work with public health teams within these three domains will enable significantly improved outcomes, reduced inequalities and more sustainable care.

There is new a shared vision for integrated care boards (ICBs), with strategic commissioning established as their central future role. Strategic commissioning, as defined by NHS England, is the continuous, evidence based process through which ICBs plan, resource, deliver and evaluate services to improve population health and equity over the long term. It comprises four stages:

• Understanding the context: ICBs will harness joined-up, person-level data and insights, including user feedback, partner perspectives, outcomes information, and public health knowledge, to gain a comprehensive and evolving grasp of their local populations and current and future needs. This includes identifying the biological, psychological, and social factors influencing risk and demand, proactively pinpointing underserved groups, and evaluating the quality, performance, and efficiency of all services available.
• Developing long-term population health strategy: ICBs will prioritise strategic planning and redesigning care pathways with a long-term perspective on population health. By leveraging national frameworks and guidelines, they will build a robust evidence base to develop new integrated models of neighbourhood care that optimize value and inform population health improvement initiatives.
• Delivering through payor function and resource allocation: ICBs will analyse and distribute resources for contracting and procuring services, oversee the provider landscape, and emphasize long-term objectives in the ongoing management of commissioned services to achieve the goals outlined in both the ICB strategy and population health improvement plan.
• Evaluating impact: ICBs will thoroughly assess the results of commissioned services, care models, and proactive interventions. This involves monitoring healthcare usage, clinical risk indicators, patient and staff feedback, outcome metrics, as well as broader input and intelligence.

The new Neighbourhood Health initiative places communities at the centre of prevention, care and recovery. It recognises that the majority of factors shaping health outcomes, including housing, employment, education, social connection and behaviours, sit outside acute healthcare services. National policy positions neighbourhood health as a core delivery model for improving population health, reducing inequalities and shifting care closer to home, particularly for people with complex or long term needs.

Neighbourhood health can be understood both as a key delivery vehicle for strategic commissioning priorities and as a practical mechanism through which population based commissioning principles are realised.

Public health teams are uniquely placed to support this approach. Their statutory responsibilities, analytical capability and long standing relationships with communities enable them to act as a bridge between local government, the NHS and voluntary and community partners. In practice, neighbourhood health tests whether systems can genuinely integrate prevention, early intervention and community based support into everyday commissioning and service delivery.

The NHS 10 Year Health Plan and subsequent national guidance establish neighbourhood health as a system wide priority. ICBs are expected to move away from transactional service by service commissioning towards population based approaches that address need across whole pathways and places. This includes a stronger focus on prevention, early intervention and reducing unwarranted variation.

In parallel, local authorities retain statutory responsibility for public health, including the duty to provide healthcare public health advice to ICBs under the NHS Act 2006. This creates a shared leadership space in which ICBs and Directors of Public Health must work closely to align priorities, intelligence and investment decisions.

The NHS England Strategic Commissioning Framework explicitly identifies specialist public health skills as essential to effective commissioning. These include population needs assessment, prioritisation, impact evaluation and a clear focus on health inequalities. Neighbourhood health therefore represents a key interface between local authority public health functions and ICB commissioning responsibilities.

There are a number of core design principles that should underpin effective public health contribution to strategic commissioning and neighbourhood health. These are by no means exclusive, but represent a solid foundation for negotiating effective partnerships between NHS bodies and public health teams. 

First, seamless integration requires public health teams to be fully embedded within neighbourhood, place based and system structures, regardless of organisational boundaries. Practical arrangements for shared posts, data access and resourcing should be agreed early and reviewed as neighbourhood health models evolve.

Second, public health teams should occupy a core strategic role. Rather than simply being seen as a support function operating at the margins, Directors of Public Health and their teams must be key partners in shaping priorities. This includes influencing neighbourhood health objectives, advising on prevention focused investment and ensuring that decisions are grounded in the best available evidence.

Third, role clarity is crucial. A clear and structured contribution ensures that roles, responsibilities and capacity are explicitly defined. This is particularly important where public health teams support multiple neighbourhoods or multi neighbourhood providers, helping to avoid duplication, confusion or unsustainable expectations.

Effective delivery of neighbourhood health requires clarity on governance, capability and workforce arrangements. National guidance stresses the importance of maintaining specialist public health capacity and professional leadership as systems undergo organisational change.

This includes agreed governance arrangements between ICBs and local authorities, sustainable resourcing models, shared data infrastructure and clear accountability for outcomes at neighbourhood, place and system levels. NHS investment in public health capability is a critical enabler of effective strategic commissioning.

In defining public health support to the NHS, local negotiation and adaptation will be required. Work should be undertaken to find the best fit between what is needed, and what is possible. In addition, as ICBs will usually cover multiple local authorities, coordination across public health teams is essential to ensure consistency, avoid duplication and maximise the impact of the available resources.

The support provided by public health teams should reflect and build on what they already do. It should play to their strengths and unique position in the wider health and social care system. The following sections set out three domains of public health support. As already discussed, the exact level and type of support will depend on local public health capacity and resources.

Domain 1: Insight and intelligence

Areas of analytical support from public health teams to NHS partners may include:

• data analytics (including population segmentation and risk stratification) 
• needs assessment (including future projections of need)
• data sharing (from commissioned public health services)
• local area profiles (combining health, social care, housing and socioeconomic data)
• evidence reviews (including local needs assessment, cost-effectiveness and return on investment assessments).

Insight and intelligence form the foundation of both neighbourhood health and strategic commissioning. Public health teams bring specialist expertise in population segmentation, risk stratification and the integration of quantitative and qualitative data to inform decision making.

At neighbourhood level, this includes the development of detailed neighbourhood profiles that combine health outcomes, service utilisation, social care data, housing conditions and socioeconomic indicators. These profiles support neighbourhood teams to understand need, identify priority cohorts and tailor interventions accordingly.

Public health teams can also support data sharing from their own commissioned services, such as substance misuse treatment or weight management programmes, enabling a more complete picture of population need and service impact. Evidence reviews, including cost effectiveness and return on investment assessments, help commissioners prioritise interventions that deliver the greatest population benefit.

The strategic commissioning framework emphasises the importance of integrated needs assessments and person level data to inform long term planning. Public health intelligence functions can therefore act as a shared system asset, supporting ICBs, place based partnerships and neighbourhood providers.

For support on insight and intelligence to make a meaningful contribution, public health teams will require access to data. Systems should avoid allowing inadequacies in data sharing to hinder the contribution public health teams can make. While information governance guidance should be adhered to in order to protect personal data, this should not restrict access to the point that opportunities for improvements in care are missed.

Domain 2: Health improvement services

Areas of health improvement support may include:

• healthy lifestyle support (including Tier 2 weight management and smoking cessation)
• strength, balance and falls prevention (Tier 2)
• substance misuse services (including treatment and harm reduction)
• health protection and sexual health
• children’s public health (including health visiting, school nursing and family hubs)

Public health commissioned health improvement services provide practical, preventative support that can be directly aligned with neighbourhood health and strategic commissioning ambitions. These services form a critical component of upstream prevention and demand management.

This domain includes healthy lifestyle support such as Tier 2 weight management and smoking cessation, strength and balance and falls prevention programmes, substance misuse treatment and harm reduction, sexual health and health protection, and children’s public health services including health visiting, school nursing and family hubs.

Within strategic commissioning, these services support pathway redesign by reducing avoidable illness, preventing deterioration and enabling earlier intervention. They also provide measurable evidence of impact through population level outcomes, supporting commissioners to demonstrate value and sustainability.

NHS England guidance emphasises prevention and early intervention as essential to improving outcomes and managing long term system pressures. Aligning health improvement services with neighbourhood health and strategic commissioning priorities is therefore a core strategic task.

This domain should also include support on health protection. In collaboration with the UK Health Security Agency, local public health teams already provide a local system of prevention and response to infectious disease. In addition, public health teams can provide an important contribution to the uptake of screening and immunisation programmes. This is particularly true in relation to tackling inequalities in uptake across socioeconomic and ethnic groups.

Domain 3: Community engagement and development

• facilitation of service co-design and consultation
• asset-based community development programmes 
• behaviour change campaigns (including tailored campaigns with priority groups)
• liaison with voluntary sector, housing, education and leisure services.

Neighbourhood health depends on trust, relationships and community capability. In the same way, effective strategic commissioning within the NHS can be enhanced by enabling communities to be active partners in service design and delivery. Aspirations for improved health and reduced service demand cannot be achieved by the NHS professionals in isolation.

Public health teams have long standing expertise in community engagement, co production and asset based community development. Key contributions include facilitating service co design with residents, supporting voluntary, community and social enterprise partners, and leading or contributing to behaviour change campaigns tailored to priority groups. These approaches help ensure that neighbourhood health models are responsive, inclusive and culturally appropriate.

Public health teams also act as a bridge between neighbourhood providers and wider local authority functions such as housing, education, leisure and community safety. Both the strategic commissioning framework and DHSC guidance emphasise the importance of lived experience and community voice in shaping priorities and evaluating impact.

Neighbourhood health and strategic commissioning are mutually reinforcing agendas. Public health professionals play a critical role in ensuring that both are grounded in evidence, equity and community partnership. By applying the principles and domains set out in this guide, public health teams can help systems deliver healthier places, improved outcomes and more sustainable care for their populations.

The support of local public health teams to strategic commissioning and neighbourhood heath will differ across the country, as a function of both need and capacity. This should be negotiated with sensitivity to what is possible and involve effective collaboration between public health teams within an ICB cluster. Memorandums of understanding or other forms of agreement will aid clarity and duplication.

This guidance is intended only as a starting point to for local negotiation. As time passes, it will be important for systems to share best practice and lessons learned so that the contribution of public health teams can develop and mature.

With thanks to Professor Lisa McNally, Director of Public Health, Worcestershire County Council, for her support and informed advice in the production of this briefing.