Resetting the relationship: towards a social model of health creation and care

• Transformative change requires a major reset of relationships across the health and care system – from top-down management to trust-based collaboration – empowering frontline professionals and communities to shape and deliver local solutions that meet local needs.

• To move towards a genuinely preventative model of care, the health service will need to change how power and resources are distributed. That means giving neighbourhoods the tools and resources they need to support citizens to take a proactive approach to their own health. It is at the neighbourhood level that most of the social, economic and medical conditions of good health are to be found and where the most effective interventions can be made.

• This report summarises the findings from a national policy sprint on how the future neighbourhood health service creates the clearest path to better population health. The sprint was hosted by the NHS Confederation in February 2025 in partnership with Local Trust and supported by PPL.

• With a ten-year health plan under development, the policy sprint was a prime opportunity to define what a neighbourhood model of healthcare could look like and to work out how to embed it into the NHS in practice. The sprint’s focus was on practical policy solutions and learning from what has worked before.

• Health systems must be reoriented around outcomes, not outputs, with fewer, simpler performance metrics based on population health and inequalities, not just process-driven outputs. Giving frontline teams greater autonomy, funding prevention-focused initiatives, and developing long-term outcome-based goals jointly with communities.

• Success depends on a ruthless consistency in messaging, funding and support from national bodies focused on tackling the greatest levels of need and committing to more radical approaches to change. This should include the development of a Neighbourhood Health Fund that prioritises social infrastructure and working between statutory services and communities to support health creation in the most deprived areas.

• Despite recent cost reductions to integrated care boards and providers there needs to remain a long-term commitment to true subsidiarity – devolving decision-making and resources to neighbourhoods and places – with a particular role for place-based leadership models for driving the collaboration and infrastructure needed for this to thrive.

• A successful shift to a neighbourhood health service depends on investing in the workforce – including training NHS staff in holistic, person-centred approaches; redeploying staff into community-facing roles; and supporting the development of new roles such as link workers, social prescribers and community convenors.

• The ten-year health plan must be bold and ambitious with its plans for a neighbourhood health service, and transformation must start from day one. If not, we risk deepening community mistrust, entrenching inequality, and missing a once-in-a-generation opportunity to build a more resilient, equitable and sustainable model of health and care.

Download the report.