A new model for a Neighbourhood Health in London — what do make of it
Here’s the problem with public service ‘policy’ at the moment, in the UK. It’s hard to know what it means. https://www.linkedin.com/posts/antlerboy_neighbourhood-health-service-london-case-activity-7333028795869757441-xMFr Is the Neighbourhood Health Service model for London a pragmatic, inspirational rallying cry — or a siren song?
Here’s the problem with public service ‘policy’ at the moment, in the UK.
It’s hard to know what it means.
The NHS in London has published a target operating model for a ‘Neighbourhood Health Service’. It proposes integrated neighbourhood teams (INTs — get used to the jargon!), built from primary care, social care, mental health, VCSE, and community support, working around populations of 30–50k. A ‘team of teams’ model. Local integrator organisations. Hyper-local intelligence. Shared data platforms.
All the right words! And, I think, the right ideas.
If you squint, it looks like the model we should have built from the start. And it could finally give reality to #IntegratedCare. Could.
But it’s heavy on vision, light on mechanism. There’s little clarity on funding, no real delivery plan, and no analysis of existing blockers. Who owns what? How will investment flow? Where does power shift? And under what governance? Why hasn’t this happened in the last 77 years?
These kinds of changes only succeed under very specific conditions. I have no faith we have those conditions in place, or a way to get to them. And the risk is we just make life harder by aspiring to something unachievable, pretending we’re achieving something, creating cognitive dissonance, and obscuring how things actually work.
If neighbourhoods are the new care planning unit, who gets to define their boundaries? How does this align — or clash — with existing locality models? What does this mean for stretched #AdultSocialCare teams already balancing crisis response with long-term goals? The answer in the doc is ‘work it out’ — right in theory, but in practice it doesn’t look like the extra energy and drive is there in a broken system.
The document suggests we’ll draw on ‘evolving London-wide digital architectures’ and nominate ‘integrators’ at borough level. This is an absolutely necessary precondition — and one part of the model with a funded programme. But there’s no comment on why this will work, finally, *this time*.
The fiscal reality is that systems are barely coping with rising demand and costs and workforce exhaustion and burnout. Integration won’t happen by aspiration alone — especially not when services are still absorbing 2024/25 cuts, and transformation posts are the first to go.
We know from #PublicHealth and #PlaceBased approaches that change like this takes long-term investment, deep trust, and shared accountability. And we know that #systemchange without those things ends in churn, fragmentation, and further exhausted frontline teams.
So, it reads well. It’s strategic. It includes the voluntary and community sectors. It names social care. But right now, it’s strategy without teeth — unless the next steps bring funding, governance, and real shared ownership.
Are we ready to build that? Or are we about to create another layer of reporting and language and aspiration over the same old dynamics? Is this a pragmatic, inspirational rallying cry — or a siren song?
