Neighbourhood health ‘can’t be line managed’

Sir John Oldham, a former GP who is chairing the government’s neighbourhood health implementation programme, launched a call three weeks ago for applications to join its first wave.

The “large-scale change programme” will be joined up with parallel national 10-Year Health Plan  delivery work, including developing two neighbourhood health provider contracts, and changing funding flows.

But Sir John told HSJ that successful implementation “requires the meaningful frontline involvement of partners at a neighbourhood level… You can’t line manage organisations outside the NHS into change, you have to engage and facilitate. Yet it is their contribution that will be needed [to achieve] the hard deliverables”. 

The senior adviser to health and social care secretary Wes Streeting also said the programme would not accept applications from multiple places working as one, because they would be too wide to properly engage local teams. “The connectivity between place and neighbourhood will be very important, which is why a single application from multiple places won’t be accepted,” he said. “The definition of a place is up to local people.

“From our point of view, 300,000 [population] is ideal for programme delivery, but larger places are fine if they can show how they can in real time spread the knowledge among all the neighbourhoods in their place.” The programme may accept applications from multiple places within a single integrated care board, however. 

Some 1,600 people joined an online event about the programme last week, and Sir John said the application process had sparked productive conversations and shown “energy for change”. But he said “we now have to translate that into hard deliverables” and “tackling those complex, wicked problems that will lead to reduced attendance at A&E, reduced unscheduled admissions and outpatients, as well as increasing agency to citizens”.

He said although the work will focus first on people with long-term conditions, “the mechanisms, relationships, governance and data structures that will be created will help places advance other deliverables” such as adopting neighbourhood provider contracts, and reforming urgent care and outpatients.

The first wave of 42 would also create “a gearing effect on implementation”, he said. “The more examples we create, the easier it is to diffuse throughout all places.”