Government’s Neighbourhood Health Framework signals a significant shift in the future of health and social care delivery across England. Central to the framework is the development of local Neighbourhood Health Centres, designed to bring a wide range of services together within communities. These centres are expected to include GP services, community nursing, rehabilitation, mental health support, diagnostics, social care and wider wellbeing services, helping people access support closer to home and reducing pressure on hospitals and emergency departments.
For the care sector, the framework reflects a growing recognition that supporting people’s health and wellbeing extends far beyond medical treatment alone. It highlights the importance of partnership working between health providers, local councils, voluntary organisations, family support services and community groups to help individuals remain healthier, more independent and better connected within their communities.
The emphasis on prevention, healthy ageing, social connection and community-based support is particularly relevant for care providers working with older adults, vulnerable individuals and families. As the framework develops over the coming years, there may be increasing opportunities for the care sector to work more closely with healthcare professionals and local organisations to deliver holistic, person-centred support that improves quality of life and helps people remain independent for longer.
Does the framework clarify social care’s role?
The framework is clear that neighbourhood health is a joint endeavour between the NHS and local authorities, explicitly combining the NHS’s responsibility for health services with the local authorities’ responsibilities for adult and children’s social care and public health. This is a stronger statement than earlier neighbourhood or place‑based policies, which often implied rather than spelled out social care’s role.
The framework defines neighbourhood health as organising services around people, including:
- GP and community health services.
- Urgent and outpatient care.
- Local‑authority‑commissioned services such as adult social care and public health.
This helps address long‑standing concerns that ‘neighbourhood health’ might be NHS‑only in practice. The framework links neighbourhood health delivery to outcomes that matter directly to social care, such as supporting people to live independently at home, preventing avoidable admissions to residential or nursing care and improving experiences of service users and carers. This gives social care a clearer outcomes-based rationale for involvement, rather than just a supporting role.
Neighbourhood health plans are to be developed under the collective leadership of Health and Wellbeing Boards (HWBs), which already have statutory NHS and local authority membership. This reinforces social care’s role in strategic priority-setting, not just delivery.
Where clarity is still lacking
The framework does not change statutory or funding responsibilities for social care. While this avoids upheaval, it leaves unanswered questions about how increased community or preventative demand will be funded and whether costs will shift from the NHS into already‑stretched social care budgets. Sector bodies have warned of the risk of unfunded demand transfer.
Although social care is acknowledged as a partner, the five national minimum goals and metrics are largely framed around NHS pressures (access, urgent care, hospital alternatives). Care England notes that this risks neighbourhood health becoming ‘NHS‑led integration’, unless local systems actively rebalance priorities.
The framework promotes multidisciplinary neighbourhood teams, often including social care providers, but it is vague on who leads day‑to‑day co-ordination and silent on how independent social care providers influence decisions at neighbourhood level. This could result in uneven influence across areas, depending on local relationships rather than clear national expectations.
Critical questions unresolved
The Neighbourhood Health Framework represents a meaningful step forward in clarifying social care’s role: explicit inclusion (not just rhetorical integration), shared outcomes and reinforced joint governance. However, it stops short of full clarity, particularly on funding flows, operational authority and parity of influence alongside the NHS. As The King’s Fund summarises, the framework provides ‘long‑awaited clarity’ on intent but leaves critical questions about delivery and capacity unresolved.
Local authorities and social care providers are rightly identified as key partners in the delivery of neighbourhood health in Government’s recent Neighbourhood Health Framework. But detail of their roles is scant. While the framework helps to clarify the purpose and vision for neighbourhood health, it is for local areas to decide how they will make it a reality, leaving much uncertainty. From defining ‘neighbourhood’ boundaries and how to constitute neighbourhood health teams to designing local pathways to improve proactive care, local partners are expected to work collaboratively to determine the right approach for their local population. This includes a recommendation for partners to identify how neighbourhood health can help improve outcomes for adult social care. While the scale of the ambition is admirable, the reality is complex. Success – the framework notes – will depend on transforming how partners work together, breaking down long-standing barriers to integration. In reality, collaboration between partners with different cultures, approaches to risk, workforce challenges and financial pressures is unlikely to be straightforward. Questions also remain about how the multitude of complex providers in the social care market will be involved meaningfully in decision making. Furthermore, building successful partnerships will inevitably rely on the already stretched capacity of integrated care boards (ICBs) and Health and Wellbeing Boards to foster those relationships. While local authorities are identified as an important partner, many of the goals remain dominated by NHS metrics and clinical outcomes, and there is a risk that collaboration is overlooked in the face of more immediate pressures. Evidence from previous attempts to integrate services shows local authorities can be crowded out by the NHS, especially in a fragmented system where roles are unclear or dependent on the quality of local relationships, especially as the framework has landed at a time of large-scale structural change for both the NHS and local government. Plus, if neighbourhood health becomes predominantly about clinical outcomes, it could miss opportunities for services to work together to improve people’s health more broadly, including with social care services. Rachel Hutchings, Fellow, Nuffield Trust. Email: [email protected] LinkedIn: @Rachel-H.
Adult care providers are unsure about what role (if any) they will play in Government’s Neighbourhood Health Framework. This may, in part, be due to the fact there is still a lot of confusion surrounding its implementation. Social care providers could and should be a vital component of the delivery of care for those living with frailty and reaching the end of life in older age. We can reduce the need for acute hospital visits by preventing avoidable urgent care needs, and we can support those who do need hospital care to return home as quickly as possible. Social care providers are the experts in making the best of the last years of life. However, our expertise is being ignored as local Neighbourhood Health Plans are being developed with local health and wellbeing boards. The national guidance is helpful but many areas started their planning before it was issued, so once again the private social care sector is being left out. To play our part in the Neighbourhood Health Framework, care providers need recognition – particularly for registered nurses working in social care. We also need clear governance relating to how care and support staff can be safely and effectively supported to deliver tasks delegated by nurses and other professionals. If this can be made to work, we could transform the way in which older people and those living with disabilities experience integrated care; conversely, if this is done piecemeal and haphazardly, it could be a disaster. In some parts of the country, care providers and their representatives are engaged in challenging discussions around neighbourhood health. Lincolnshire Care Association has been working closely with the health and wellbeing board and NHS colleagues to establish how neighbourhood health should be delivered. These conversations can be challenging, but we offer good value to the system and make sure that the care provider voice is heard. Our message to the Government is this: give adult social care providers the opportunity and we will help you to deliver care closer to home. Shut us out and our hospitals will continue to be full of frail older people who do not need to be there. Melanie Weatherley MBE, Co-Chair, Care Association Alliance and Chair, Lincolnshire Care Association. Email: [email protected] LinkedIn: @Care-Association-Alliance