Written by Marc Harris, Head of Insight and Impact, NHS Horizons
Across four regional learning events in October and November 2025, nearly 1,000 people came together through the National Neighbourhood Health Implementation Programme (NNHIP). Different places brought different challenges, but the learning that emerged was strikingly consistent. A set of shared insights are emerging about what helps neighbourhood health take root and grow.
At the heart of it all is a simple truth: relationships are the infrastructure. Again and again, places making the most progress pointed to the time and effort invested in building trust -across organisations, with communities, and within teams themselves. This isn’t a “nice to have” alongside delivery. It is the work. Where relationships are strong, collaboration becomes easier, decisions move faster, and teams feel able to take the kind of risks that change requires.
That relational foundation shows up most clearly in how teams work together. The idea of a “one team” approach only becomes meaningful when it’s experienced in practice, through shared purpose, joint accountability, and everyday collaboration. In the most effective places, this is visible and tangible. People know who is “in the team”, they use common language, and they work in ways that reduce handoffs and fragmentation. Often, it’s the small signals, like shared spaces, regular touchpoints, and informal connections, that make the biggest difference.
Alongside this, there is a clear shift in how services are designed. The strongest examples of neighbourhood health start with people. They begin by asking what matters to residents and then shape support around that. This means working differently with communities and treating voluntary and community sector partners as equal contributors, investing in long-term relationships, and creating genuine opportunities for co-production. It also means recognising that health is shaped as much by connection, housing, and income as it is by clinical care.
“This programme is built on a simple but profound ethos: ‘do with’, not ‘do to’. It represents a unique and powerful opportunity to shape how neighbourhood health is delivered across the country. The answers aren’t “up there”- they’re right here, in our places, our partnerships, and our communities.” - Dr Minal Bakhai, SRO National Neighbourhood Health Implementation Programme, Director for Primary Care and Community, Transformation and Improvement, General Practitioner, NHS England
What’s enabling progress in these environments is not a fixed model, but a learning mindset. Teams are testing ideas, adapting quickly, and building confidence through doing. Leadership plays a critical role here by creating the conditions for curiosity, reflection and safe experimentation.
"In the SW we have just had a regional event with our VCSE and systems to talk NbH- was a really great day. It was co-designed between regional and the VCSE alliance (not NHS led!). 100 people, did a whole day on NH through the lens of VCSE, fishbowl exercise across all systems, exploring ways of working, finance streams, added value." - Jen Tomkinson, South West
There are, of course, practical enablers that matter. Data, for example, is most powerful when it is usable, shared and aligned to neighbourhood-level priorities. The same is true for funding, where progress is strongest when resources are flexible, locally shaped, and focused on what creates value for people and communities. In both cases, the direction is clear, even if the system has further to travel.
Perhaps the most important insight, though, is that this work is not about resolving complexity, it’s about working with it. Neighbourhood health requires balancing tensions: between national priorities and local autonomy, between acute demand and prevention, between population health data and lived experience. The places moving fastest are not trying to eliminate these tensions, but learning how to hold them, navigate them, and move forward anyway.
"We have moved away from starting big picture and instead taken lots of good ideas around frailty and designed a Test of Change in each of our neighbourhoods, which then links to the policy question of what do we do when we find out this works to scale up; knowing that we are borrowing and stealing just to do the initial tests of change, but we won't be able to scale up without the investment upfront; this is linked to the Prevention Demonstrator work that is looking to answer this. Started to explore which parts of the models might work for us, embracing bottom up set of ideas, recognising at some point we need to bring it into a whole." - David Segal, Stockport
Taken together, these insights point to a broader shift. Neighbourhood health is not simply a new way of organising care. It is a different way of thinking about health itself, one that starts with people, builds through relationships, and evolves through continuous learning. The answers are not waiting to be discovered elsewhere. They are already emerging, in real time, in the places and communities doing the work.
