Neighbourhood health framework: Initial observations for social care clients

The neighbourhood health framework has been published as a joint policy paper by NHS England and the Department of Health and Social Care.

Although it is primarily addressed to Integrated Care Boards (ICBs) and NHS providers, neighbourhood health is explicitly framed “as a joint endeavour between the NHS and local authorities [...] combining the NHS's responsibility for health services with local authorities' responsibility for adult and children's social care services and public health”. Local authority leaders therefore need to engage with this framework as active participants, not merely as consultees.

Shape of neighbourhood working and local authority role

The framework is intended to provide a structure for delivery of health and care that is responsive to the needs of neighbourhood populations. While setting some common outcomes, it envisages these being supplemented with local priorities, and responses that are tailored.

The key mechanism for identification of priority outcomes is the Health and Wellbeing Board (HWB). Neighbourhood health plans will be designed under the collective leadership of HWBs, with HWB members required to work with communities, health and care organisations and wider partners to establish outcome measures covering the whole life course and reflecting both health and social care needs.

ICBs will work with local authorities to agree how to design and deliver those aspects of neighbourhood health that require joint working across the NHS, social care and other local services. Of course, this framework does not alter the responsibilities, accountability or funding responsibilities of local authorities in relation to adult care and children’s services. 

How does adult and children's social care fit in?

On adult social care 

ICBs and local authorities are recommended to work with HWB partners to identify how neighbourhood health can improve outcomes for adult social care, including the proportion of people enabled to live at home or with family, numbers admitted to residential and nursing care, and overall satisfaction of service users and carers.

On children's services 

Existing reform programmes are seen as complementary to the move to neighbourhood healthcare. Developments in areas such as family hubs, family help and safeguarding, with an emphasis on early intervention and on keeping children in their families and communities is consistent with the aims of the framework. Of course, the need to cooperate across health and care to support children’s safety and wellbeing is well established. 

In relation to the very live topic of SEND, the framework identifies existing work between local government and health, and the future requirement for “Experts at Hand” offers to provide early support.

Key clinical priorities

The framework is outcome-focused but sets clear national minimum goals.

For people with mid to severe frailty, in a care home or housebound, the “aim is to reduce non-elective admissions and bed days by 10% by March 2029”. For end of life care, targets include increasing identification of people approaching end of life by 10% and reducing non-elective admissions for that cohort by 10%, both by March 2029. Key long-term conditions targeted include cardiovascular disease, diabetes, COPD, dementia, and mental health conditions. 

Structure vs outcomes

The stated focus is on outcomes, not organisational form, with ICBs responsible for ensuring neighbourhood health is the default for NHS care provision. However, in practice the framework is heavily structural, introducing several new contracting vehicles - Single Neighbourhood Providers (SNPs), Multi-Neighbourhood Providers (MNPs) and Integrated Health Organisations (IHOs) - which will reshape how services are commissioned and contracted across local health economies. 

These developments (alongside changes in children’s services and care) are likely to complicate the road to collaborative working, through the ongoing need to build shared understanding of working practices and relationships, and the need to bridge people and processes between organisations that are themselves changing.

Points of specific relevance to legal teams

1. Governance 

The framework creates governance archetypes to support neighbourhood health and commits to a new approach to joint working across NHS and local government leaders, including more collaborative strategic commissioning. 

2. Funding and public-private partnerships

There is a commitment to develop “early financial incentives to support local systems to accelerate change”. It seems there may be opportunities to secure funding for innovative and impactful neighbourhood working.

For neighbourhood health centres, there is a target of 250 by 2035, with 20% of new builds funded from public capital and the remainder through public-private partnerships.

3. Contracting and commissioning changes

The framework sets out that neighbourhood health will be delivered through commissioning reform, meaning changes to existing ways of working and contracts, with options to develop population health contracting including single and multi-neighbourhood provider contracts, and incentive and outcomes-based contracting at greater scale.

NHS contracts will be developed to deliver this change. We can expect similar vision for aspects of care which interface closely with health, with a need for contracts that will work in the neighbourhood context.

4. Workforce

The framework tells us that “The shift to neighbourhood health will entail a fundamental reimagining of the roles, skills and ways of working across health and social care over the next decade”. Local authority employers and their legal teams will need to think early about implications for employment contracts, terms of service and possible risks as roles shift across organisational boundaries.

There is no significant detail as to how change will be delivered in these areas, and legal teams will need to work with their internal clients, external providers, system partners, and national organisations to develop models to respond to the neighbourhood shift. 

Timetable

The framework operates in two stages. Stage 1 requires ICBs to deliver minimum requirements in 2026–27, including agreeing neighbourhood footprints and INT plans. 

For longer-term reform from at least the 2027–28 financial year, ICBs should work with HWBs and their partners to develop a locally owned neighbourhood health plan. Local authorities should expect to be engaged in that planning process imminently.

Neighbourhood health legal support

We have extensive experience of working with health and care organisations through change and transformation projects and are currently engaged in a programme of work on the shift to neighbourhood, which will deliver practical insight and tools to support successful transitions. To learn more and sign up for updates, please visit Neighbourhood working: Policy to practice or contact james.arrowsmith@brownejacobson.com.