In his blog, Mike Barker argues that neighbourhood health must be treated not as a service redesign but as a way of governing, rooted in local leadership, relationships and genuine devolution if national policy intent is to become lived reality.
The publication of the Neighbourhood Health Framework marks a significant moment. Not because it invents neighbourhood working – councils, the NHS and communities have been doing this for decades – but because it finally aligns national policy, accountability and incentives behind a way of working that local leaders know makes sense.
For the Local Government Association, the key question is not whether neighbourhoods matter, but what kind of neighbourhood system England now needs – and what it will take to make it real rather than rhetorical.
Neighbourhoods are not a delivery unit. They are a way of governing.
One of the most important signals in the framework is what it doesn’t prescribe. It does not define neighbourhoods as a single organisational form, nor does it insist on a uniform footprint. Instead, it recognises that neighbourhoods are about how services organise themselves around people’s lives, not how organisations defend their boundaries.
This matters for local government. Councils have long understood neighbourhoods as civic spaces: places where health, housing, education, employment, safety and belonging intersect. The risk, if we are not careful, is that neighbourhood health becomes reduced to a service reconfiguration exercise – new teams, new contracts, new buildings – without the deeper shift in power, culture and decision-making that makes neighbourhoods work.
The framework gestures in the right direction by rooting neighbourhood health in Health and Wellbeing Boards, joint planning, and local democratic leadership. But success will depend on whether neighbourhoods are treated as the default organising principle for public services, not a bolt-on reform programme.
The real prize is prevention – but prevention is relational
The document is clear about intent: shifting from hospital to community, from sickness to prevention, from fragmentation to coordination. These are familiar ambitions. What is different is the explicit focus on integrated neighbourhood teams, proactive care, and population-level accountability.
Yet prevention does not flow automatically from new structures. It flows from relationships – between professionals, between organisations, and crucially between the system and communities themselves.
Local government brings distinctive strengths here. Councils understand communities not just as service users, but as citizens with assets, networks and agency. Neighbourhood working succeeds where it builds on what already exists: voluntary and community organisations, informal support, trusted local spaces, and neighbourhood leadership.
If neighbourhood health is to reduce inequalities rather than simply manage demand, it must be designed with communities, not just for them. That means co-production, not consultation; shared priorities, not centrally defined targets alone.
Estates and teams matter – but culture matters more
The commitment to new and upgraded neighbourhood health centres is welcome. Too much care is still delivered from buildings that are unfit for modern practice or disconnected from everyday community life. Co-located, accessible neighbourhood hubs can make joined-up care easier for staff and simpler for residents.
But bricks and mortar will not deliver neighbourhood health on their own. Nor will reorganising teams.
The harder task is cultural: shifting from organisational optimisation to place-based stewardship. That means:
- leaders willing to share power and credit
- professionals supported to work across boundaries
- systems that value learning and adaptation over rigid compliance.
Local government has a critical role in holding this line. Councils are not just delivery partners in neighbourhood health; they are place leaders, convenors and democratically accountable stewards of long-term wellbeing.
Neighbourhoods test how serious we are about devolution
The framework speaks explicitly about devolving power to local areas and enabling local choice. This is welcome. But neighbourhood health will quickly expose whether devolution is real or conditional.
True neighbourhood working requires:
- flexibility in funding flows
- tolerance of local variation
- permission to align health investment with wider social and economic priorities.
Councils and ICBs will need room to shape neighbourhoods that reflect their places – urban or rural, dense or dispersed, with different histories and civic infrastructures. A one-size-fits-all model would undermine the very outcomes the framework seeks to achieve.
For the LGA, this is a moment to press the case that neighbourhood health cannot succeed without strong local government at its core – politically led, financially sustainable, and treated as an equal partner, not a delivery arm of the NHS.
From programmes to practice
Perhaps the greatest risk is that neighbourhood health becomes another programme layered onto an already crowded reform landscape. The framework itself acknowledges this danger, stressing the need to build on what exists rather than disrupt good local practice.
The challenge for local leaders now is integration in the fullest sense: aligning neighbourhood health with family hubs, adult social care reform, public health, employment support, housing, and community safety. Done well, neighbourhood health becomes the connecting tissue of local public service reform.
Done poorly, it becomes another set of meetings and metrics.
A test of leadership
Ultimately, neighbourhood health is not a technical challenge. It is a leadership one.
It asks whether we are prepared to:
- design services around people rather than institutions
- trust local leaders and communities
- invest upstream even when pressures downstream are intense
The conditions are more favourable now than they have been for years. National policy is aligned. The case for change is widely accepted. Local government and the NHS have a shared interest in making this work.
The task ahead is to turn intent into lived reality – neighbourhood by neighbourhood, place by place.
If we get this right, neighbourhood health will not just improve services. It will help rebuild trust in public institutions, strengthen local democracy, and remind us that the best public services start close to home
Mike Barker,
Deputy Chief Executive,
Oldham Council