On entering government, the health secretary declared the NHS broken. Fixing it will mean embedding local leadership at heart of the health system – and particularly in the design of a Neighbourhood Health Service.
As the chancellor prepares her Spring Statement, all eyes will be on the Government's ability to navigate choppy fiscal waters and the spending envelopes the Treasury imposes upon departments.
Officials in the Department of Health and Social Care will undoubtedly be weighing the generosity of their settlement against major ambitions to reform the NHS – including through the 10 Year Plan and creation of a new ‘Neighbourhood Health Service' – which aim to focus the health system much more on prevention and care in the community.
Despite being responsible for around 90% of activity in the NHS – and core to preventing illness and treating people in communities – primary care currently constitutes a small share of the health budget. In 2021-22, nearly six times more funding was allocated to acute services than to primary care.
The success of the Compassionate Frome project demonstrates the power of empowering local leaders and providing them with the resources necessary to establish local services suited to their populations needs
Against this backdrop, ‘efficiency' will be the watchword of the chancellor's statement. Architects of the Neighbourhood Health Service may therefore be very tempted to build on the present direction of travel in primary care, towards delivery ‘at scale' through PCNs and federations of GP practices – to achieve these efficiencies. For example, to share back-office functions and replicate certain, efficiency-oriented ways of working across ICSs (indeed, the Health Secretary last week appointed a GP to advise on the creation of this Service).
It would be a mistake not to consider more radical reform.
For the Government to build an NHS fit for the future – one which genuinely achieves the most bang per taxpayer pound – the much bigger prize would be to radically devolve resources to local leaders, enabling them to redesign services around recognisable, hyper-local neighbourhood footprints.
This would allow local leaders to proactively target the determinants of health head-on – moving from the current, medicalised model of primary care, to a holistic one, that creates health in communities and avoids much more costly, reactive treatments.
As new research from Reform Think Tank – informed from interviews with leading health and local government expert – indicates, there are already incredible examples across Britain that the Government can learn from.
Rather than attempting to dictate what neighbourhood health should look like top-down, it should learn from these examples to empower local leaders, unleash the frontline, experiment and design new neighbourhood services.
Consider the ‘Compassionate Frome' project – a community service which proactively and systematically identified vulnerable people and sought to link them with, and develop new and existing, community assets to help address a loneliness crisis. The project mapped and leveraged social networks and community assets and helped establish new community services where it saw gaps that needed filling.
They used ‘community connectors' to signpost people to community services, and ‘health connectors' who helped them set health and wellbeing goals. Between April 2013 and December 2017, emergency admissions decreased in Frome by 14%, compared to a 29% increase across Somerset. This also led to huge savings in healthcare costs; in Frome, healthcare costs fell by 21% whereas across Somerset they rose by 21%.
The success of the Compassionate Frome project demonstrates the power of empowering local leaders and providing them with the resources necessary to establish local services suited to their populations needs.
In South Ayrshire, the council adopted a new leadership model which sought to provide employees with the power and support needed to improve outcomes. It also committed to working together with residents and community organisations and mobilising citizen leaders to co-design local services.
Since adoption, South Ayrshire has seen marked improvements in the health outcomes of its population. Devolving power from senior leaders to frontline workers, and encouraging collaboration with communities, is a necessary step in reorienting health and care around neighbourhoods and communities – in turn, improving outcomes and lowering costs.
As interviewees for the project told us, every part of the future health system we want is already happening somewhere. The goal for government must be to create the conditions for responsive, prevention-focused services to happen everywhere.
This means ensuring local leaders are empowered to design services around its users, at a true neighbourhood level.
Florence Conway is a researcher and Patrick King is a senior researcher at Reform Think Tank
