What does this mean for the national level?

The role of national bodies, such as NHS England, DHSC and HM Treasury, as well as national charities and organisations, is to create the conditions and permission for change and to inspire the advancement of neighbourhood working as a core part of delivering on a broad set of policy goals. 

National frameworks and policy documents such as the Fuller stocktake provide valuable guidance and validation for the work being done at the local level. However, the hyper-local nature of these initiatives and their adaptation to local contexts does not lend itself to a standardised or directive model of change. This means taking a high-trust and light-touch approach to supporting and funding change and monitoring progress. 

In addition to the practical steps at the neighbourhood and system and place level set out in the previous section, we have also identified specific policy recommendations at the national level which would facilitate good neighbourhood working to develop.

• NHS England and the DHSC need to embed these ideas in the new ten-year plan for the NHS. The shift to a community-first approach should be recognised as one of the biggest change programmes in the statutory sector’s history and supported as such. The ten-year engagement planning and health mission delivery board should have a specific focus on greater devolution as part of NHS reform. prioritising new models that strengthen community-based health, unlock community assets and strengthen local decision-making.  However, they need to accept that the models have to be developed locally and resist the temptation to develop national templates and exemplars or to reinvent the project management approach used for the integrated care vanguard programme. 
• Much more devolution of decision-making and less central direction in how NHS England operates is required.  This is needed to create the space and energy for neighbourhood working to flourish. 
• NHS England should make changes to create a funding regime that is more supportive of this new settlement: 

1. Each ICS should be encouraged and empowered to use flexibility within the existing NHS Payment Scheme to support local innovation and experimentation
2. Adapt the NHS Payment Scheme in 2026 to include outcomes-based payments. This will enable ICSs to create the better financial incentives to support a leftward shift in services and resources towards primary and community care.
3. Implement the Hewitt review’s recommendations related to how non-recurrent funding is managed, with fewer stipulations on how it is used locally, and reducing the number of national targets, focusing more on outcomes than activity. 

• DHSC and NHS England should shift the NHS to multi-year funding and planning cycles aligned with local authorities, to enable long-term planning and accelerate integration in budget management, planning and delivery between health and local government. HM Treasury should help to facilitate this change.
• DHSC and the Ministry of Housing Communities and Local Government should review Better Care Fund and Section 75 arrangements and consider how they can make pooling budgets easier, including by reducing the reporting and governance requirements associated with them. 
• NHSE and DHSC should revise the GP contract to create greater devolved accountability, strengthening primary care’s capacity to play a leading role in neighbourhood health models. Reviewing the Carr-Hill formula will be key to strengthening investment in some of the most deprived communities.
• NHS England should ensure that evidenced approaches are documented and available for system, place and neighbourhood partners to draw from as they develop their local approaches. These should particularly include examples that combine community and statutory leadership.
• Cross-government action is required to promote this agenda. Government should convene cross-departmental work with an alliance of organisations at national level that are leading or driving change in neighbourhood health across health, local authority, business, communities and voluntary sector to inform future policy planning. This should include the development of more routes for schemes to obtain seed-corn funding to promote local initiatives.