Everybody needs good neighbours

Last week, the Government published new guidance for ICBs, local authorities, health and wellbeing boards and other partners to help create and deliver neighbourhood health services across England.

In a nutshell, the framework sets out some minimum expectations and targets for local areas to meet while deciding how all the relevant stakeholders in each geographical ‘neighbourhood’ will work together to deliver NHS community services, social and primary care.

These new plans aim to support the Government’s 10 Year Health Plan – its flagship policy to improve the nation’s health – and are rooted in wanting to move away from hospital care to supporting people to access health and care services in the community.

The idea is that accessing care and treatment nearer to home will be easier and less stressful, which in turn will improve both physical and mental health outcomes. This will support another of the Government’s shifts – moving from treatment to prevention.

There is nothing not to like about the ambition. However, to make both these shifts a reality and really get to grips with tackling the causes of poor health, we need strong partnership working between the NHS – the custodians of health care and treatment – local authorities – the organisations responsible for adult and children’s social care services, and public health, and the voluntary and community sector – the people on the ground who really know the communities they serve. It is also vitally important that while delivering neighbourhood health, we keep the focus on prevention, while also improving access to treatments and traditional NHS-led interventions.

This is because health is not the same as healthcare and is determined by so much more than the NHS. In fact, the NHS have relatively little to do with prevention because making sure people don’t get ill in the first place is far more reliant on creating an environment where being healthy is achievable for everyone – not just those with a good job or lots of money. And, if we do that more effectively, then the NHS can concentrate on what it does best – treating illness and keeping those people well.

Whether the Government’s neighbourhood health vision has recognised that fully is not quite clear. There is a very welcome recognition that local authorities are a key partner, but the deliverables are very much focussed on the NHS.

There is also arguably not enough recognition, at least in the documentation, that a lot of the partnerships needed to make neighbourhood health work are already in existence and working well or that Directors of Public Health, who, responsible for the health and wellbeing of residents in their area and local system leaders for health, have a key role to play in helping the new plans achieve their aim.

My colleagues in Cheshire and Merseyside have worked with local NHS leaders and other partners to develop their own framework to support the creation of the new neighbourhood health plans. All Together Fairer Neighbourhoods sets out six guiding principles which brilliantly describe what’s needed to make partnership working for better health effective:

• Co-production, collaboration and community power – building on what’s already working and sharing ownership and power to drive change.
• Marmot principles, prevention and inequalities – improving health and reducing health inequalities by improving the conditions in which people are born, grow, live, work and age, based on the work of Sir Michael Marmot.
• ‘OneTeam’ system leadership and collaboration – working across organisational boundaries.
• Outcomes, not just inputs – defining success by tangible improvements.
• Alignment and coherence – avoiding duplication to maximise impact.
• Data and intelligence – using evidence to drive decision making.

There are hundreds of examples of local initiatives up and down the country that embody these principles and, as a result, deliver real results. Many are the result of the work of Health and Wellbeing Boards, which also have an important role to play in making sure that the new plans complement wider local priorities.

There is still lots to work out like how things are funded and where things are based (250 new neighbourhood health centres will be built or upgraded), but the emphasis is on each local area to work together on the detail, with Government stressing that local leaders must own and drive the process.

Ultimately of course, neighbourhood health in this latest guise can only be deemed a success if the gap in differences in outcomes experienced by different communities and population groups is narrowed. Realistically, we won’t see those results overnight. However, by consistently working together to align our collective effort and empower our communities in a way that improves not just access to treatment, but also the wider determinants of our health, we will definitely be moving in the right direction.