Neighbourhood health was, by any measure, the defining theme of this year's NHS ConfedExpo. 

Across sessions, corridors and fringe events, it was the frame through which almost every other conversation – about finance, workforce, technology, real estate and NHS reform – was filtered. 

That ubiquity is both a sign of genuine momentum and, as more than one speaker pointed out, a source of real confusion. When it feels like every recent document relating to NHS reform features the word 'neighbourhood', the risk is that the word stops meaning anything at all.

Three sessions cut through that noise with clarity and candour:

• Neighbourhood health: Driving forward the social movement.
• Who owns health? Building trust and agency at a neighbourhood level.
• Building effective neighbourhoods: From theory into practice.

Together, they traced the arc from national ambition to frontline reality, and surfaced questions about power, practice, culture and civil society that will determine whether this agenda delivers on its promise.

Not new, but different

The starting point for any honest conversation about neighbourhood health is acknowledging that integrated, community-based care has been a policy ambition in various forms since the 1970s. What, then, is different this time?

Two answers emerged with force. The first was scale and urgency. As speakers at the 'Building effective neighbourhoods' session noted, neighbourhood working is now the government's number one reform priority, against a burning platform of worsening population health, financial pressure and unsustainable activity levels. Most parts of the NHS are already doing some version of this. The challenge is not to start, but to scale.

The second difference is the explicit framing as a social movement rather than a policy programme – the approach taken by the National Neighbourhood Health Implementation Programme (NNHIP), which brought together some of the 43 participating areas at ConfedExpo to take stock of the first six months of delivery. 

Nicola Gitsham, Head of Strategy and Policy for NNHIP at NHS England, highlighted that unless neighbourhood health is rapidly and fully integrated into how the NHS operates, the system will not cope with the pressures coming in the next two to three years.

The NNHIP's early evidence gives grounds for cautious confidence. One neighbourhood model saw 43% fewer people entering nursing care in March 2026 compared to December 2025, while 15% more patients returned home from hospital than a year earlier.

Other examples of proactive integrated neighbourhood teams have reduced A&E attendances by 38% and in-patient bed days by 52%, while readmission within eight weeks was cut from 75% to 11% of patients. 

The gap between words and deeds

The more uncomfortable thread running through ConfedExpo was the distance between the rhetoric and the reality. 

Mark Rogers, Chief Executive of Sussex and Brighton Strategic Authority, put it bluntly: many leaders say the right things, expect others to change and then go around the same loop again without examining their own behaviour. He invoked a Japanese observation that the English are skilled at planning and reviewing but tend to leave out the 'do' element. Are we, he asked, truly prepared to press the reset button?

This sentiment was echoed by others exploring neighbourhood in practical terms. For frontline staff, neighbourhood is a world that is talked about rather than one they actually work in.

The willingness to do things differently exists, but the conditions to deliver it are not yet consistently in place. Critically, several speakers pushed back on the framing of neighbourhood health as a “left shift” in which services are moved from one location to another.

That framing, it was argued, is misleading. The real goal is ensuring care is wrapped around the individual, wherever they are. When the focus is the person rather than the location, collaboration becomes easier and institutional boundaries become less important.

A clear message, and one mirrored in a recent speech by Steve Reed MP at New Local’s Stronger Things conference, was that leaders must get on with the task of making integration at neighbourhood level happen rather than waiting for further national guidance or direction. 

Leaders must think differently to work with the tools and resources already available to remove friction and amplify what already works.

Who leads, and who gets left out?

One of the sharpest tensions at ConfedExpo was around leadership and governance. There is currently no consensus on what neighbourhood leadership looks or feels like. Primary care has a strong instinct to lead, yet only about 6% of NHS organisations share that view. 

The risk of making this debate primarily about who leads is that it becomes a circular conversation about decision-making structures, with the voluntary, faith and community sector left out entirely.

While it may feel trite, the answer that emerged across multiple sessions was to start with function, not form. The importance of starting with  the model of care, then wrapping organisations and governance around it has been a key ingredient in most if not all the collaborative working we have supported to put in place in recent years.

Dr Claire Fuller, National Priority Programme Director for Neighbourhood Health at NHS England, offered the most vivid illustration of what is at stake. 

She described visiting Barrow Hill in Derbyshire – a village of about 1,200 people with little transport infrastructure, high unemployment and deep deprivation. 

There she met a GP who had spent the past two years as a trustee of the local community centre and told her he had learned more about what makes people ill during that period than in 30 years of general practice. She also visited the community's heritage room, which marked how 12% of volunteers had died prematurely through suicide, drug overdoses and other traumas. 

“If neighbourhood health is about anything, it's about communities like Barrow Hill,” Dr Fuller said.

Technology, data and the VCFSE

While digital tools now exist to support neighbourhood working in ways they did not previously technology should enable change to behaviours rather than just digitise and entrench existing processes. 

While population health management tools can identify individuals who may need support, they require clinical judgment and local knowledge to refine - people outside the system do not get identified through data alone.

The question of how to bring the voluntary and community sector into digital systems was raised but left largely unresolved. Digital solutions are still predominantly built around health and social care; there is no easy mechanism to give partners in the voluntary, community, faith and social enterprise (VCFSE) sector a shared view without onboarding them onto entirely new platforms. No reliable directory of community resources exists in most areas, while the administrative burden of involvement remains a genuine barrier.

This connects to a broader point made by Matt Hyde OBE, Chief Executive of Lloyds Bank Foundation. He said civil society is the critical third space that both the state and the market tend to overlook until a crisis makes it indispensable, as Covid-19 demonstrated when 12.4 million people volunteered. 

Less than 5% of UK public spending flows into the VCFSE sector, roughly a third of equivalent spending in countries like Germany, Canada or the Netherlands. 

“There's a view when we talk about the VCSE sector that it's a cottage industry, which we all love but it won't solve anything major,” said Matt, who urged a shift in this thinking and called for leveraging these partners to truly tap into communities. 

What we take from ConfedExpo

The overall picture from ConfedExpo is of a neighbourhood health agenda that is real, evidenced and gaining momentum, but many of the questions that will determine its long-term success are yet to be resolved. 

The structural conditions for neighbourhood health are being put in place. But the cultural and behavioural conditions lag behind, while the financial and governance architecture that would allow civil society to genuinely share in the work remain largely absent.

Our own research on neighbourhood working, developed in partnership with the Local Government Information Unit and NHS Transformation Unit and publishing in the second half of 2026, will explore how organisations are navigating exactly these challenges. ConfedExpo has sharpened our sense of where the most important questions lie.