The idea of neighbourhood health has always carried a quiet promise. It was meant to be the place where the NHS, councils, and communities finally met as equals, designing services from the street level up rather than imposing them from afar. Yet recent conversations across local government suggest that this promise is beginning to fray.
At a recent gathering of social care and local authority leaders, a moment of unexpected clarity arrived when the care minister floated a small linguistic shift. What if the neighbourhood health service became the neighbourhood health and wellbeing service? It was an offhand suggestion, but in the room it landed like a truth long known and rarely voiced. Health is not a clinical pathway. It is the totality of people’s lives, shaped as much by housing, work, safety, and connection as by the NHS.
For many in local government, this reframing spoke directly to a growing anxiety. Neighbourhood models are advancing, but the gravitational pull of the NHS is unmistakable. The dominant conversations are still about admissions, length of stay, acuity levels and hospital avoidance. All are important, but none can substitute for genuine place shaping. As one council leader put it with unvarnished honesty, local government often feels invited late and listened to selectively.
Jess McGregor, who leads the Association of Directors of Adult Social Services, captured the unease with precision. The question, she argued, is not how quickly we can reduce flows into hospital, but how well we can improve the conditions of daily life so fewer crises happen in the first place. That principle is central to neighbourhood working, yet many social care leaders already feel they are losing ground in shaping the wider determinants of health.
A parallel concern is emerging in governance. National proposals to remove local authority voting members from integrated care boards and replace them with a single mayoral representative have been met with disbelief. In some regions this could reduce more than a dozen local authorities to one voice. The symbolism is hard to ignore. A model built on partnership risks becoming one where legitimacy narrows and accountability tilts decisively toward the NHS.
Structural turbulence is compounding the problem. Both NHS and local government are navigating their own reorganisations, consuming time and attention that neighbourhood models urgently need. Longstanding mechanisms for scrutiny are under review. Data systems remain incompatible. Staff work under divergent contracts and conditions. These are not the foundations of seamless integration, and leaders know it.
Yet beneath the frustration there is still consensus. Neighbourhood health is the right direction for the country. It is the closest thing England has to a renewal of prevention, community resilience and truly person centred care. From 2026, health and wellbeing boards will be required to produce neighbourhood health plans with NHS and local partners. Whether these plans become engines of place-based innovation or another administrative exercise will depend on how honestly the system confronts the tensions emerging now.
The risk is not that neighbourhood health fails through lack of enthusiasm. The risk is that it quietly becomes something else entirely: a clinical programme with a community label. Local government leaders fear that trusts, armed with strategies and capacity, will step into the vacuum and define the model by default.
If neighbourhood health is to mean anything, its leadership must remain anchored in place, not institution. Health and wellbeing boards should guide the agenda, ensuring that the lived realities of neighbourhoods are not overshadowed by hospital pressures or central directives. England does not need another NHS led transformation with local government in a consultative role. It needs a model shaped jointly, early, and with the full weight of local knowledge behind it.
A neighbourhood is not a service line. It is a community. And if the system forgets that, the most promising reform of the decade may lose its purpose before it has the chance to deliver.
