Why is this hard?

Our research also investigated the barriers and challenges to more effective and widescale neighbourhood working. Across the sample some key shared barriers emerged, a number of which related directly to those areas that were identified as ‘making this work’:

• Funding. Several of the case studies were reliant on multiple or diverse funding streams. While diverse funding streams can be helpful in mitigating risks of funding suddenly ending from a single source, this also requires significant ongoing management, while wider fundraising efforts can distract from service delivery.  Neighbourhood working often addresses wider determinants of health and aspects of health and wellbeing that may only realise benefits for statutory partners in a diffuse way or over a longer timeframe than current budgeting and planning rounds. A lack of flexibility in funding and a dependence on pilot approaches can also prevent interventions from adapting to neighbourhood needs or allocating resources towards the highest priority activities as these evolve over time. While funding made available to support health inequalities could be a source of support, this was not always easy to access at a neighbourhood level and was often non-recurrent, preventing building up a sustainable offer to local communities. 
• The definition of a neighbourhood and communities. In most cases, local people will define neighbourhoods in ways that do not align with statutory services and vice versa. This does not have to be a barrier but can become one when local discussions become stuck at the definitional stage, and / or there is a lack of readiness to accept a degree of imperfection in coming to compromises around where and how to define boundaries. What is true of neighbourhoods as geographic units is even more complex in relation to the communities that live in and across them. Successful community-led interventions were ones that had been able to navigate these complexities with statutory partners without losing focus on the importance of ‘getting on and doing things’ with shared benefits for those involved.
• Reliance on a few leaders who ‘get it’.  Successful case studies were able to build connections often due to the efforts of locally influential leaders who were willing to invest in neighbourhood working and community development.  While this may be a necessary precondition to successful neighbourhood working in future, it creates issues both if individuals leave their current posts or are otherwise unable to continue the work, and for all of those areas where equivalent individuals are not yet identified or working in this way. 
• Balancing immediate needs with longer term solutions. The priority around neighbourhood working, including the development of INTs within the NHS, relates to challenges that are impacting communities and the services that support them today. However, this can lead to a temptation to focus on short-term solutions and objectives, including those that address symptoms rather than causes.  For most areas, there will be a need to construct a business case for investment that balances both short- and long-term opportunities with needs.
• Data and information sharing.  Within our statutory partnerships it can be difficult or impossible to share data across different teams, organisations and systems. This has a direct impact on the ability to co-ordinate service delivery and to evaluate the impact of existing and new interventions. When this is extended to community-led initiatives, supported by VCSE organisations, the challenges are exacerbated. If statutory partners want to work in a more integrated way with VCSEs, communities and individuals, as information systems and governance evolve it will need to take into account the risks of both sharing and not sharing information outside of traditional structures and silos.
• Managing and responding to diverse and conflicting views. Diversity exists at all spatial levels but is often lost in the need to aggregate requirements and standardise approaches. Part of the power of neighbourhood working is the ability to recognise and respond to diverse needs, but to do so effectively there needs to be a recognition that even in a single street residents will have different cultures, beliefs and opinions on their needs and priorities. Reaching consensus can be a challenging process and neighbourhood-based working needs to be particularly mindful not to simply adopt the ‘loudest voices’ when making decisions that need to be genuinely participatory. 
• Reliance on volunteers and high volunteer turnover. Many of the case studies rely on volunteers who provide energy, passion and dedication to the communities and neighbourhoods they support. However, this reliance can pose a risk as turnover among volunteers can be high, which can sever individual ties with residents and incur additional overheads in regularly having to onboard new volunteers.  The availability of volunteer time was not found to be evenly distributed across the places we engaged, disadvantaging some neighbourhoods that have a smaller pool of volunteer time to draw upon.  Overall, there is a balance to be struck between ‘professionalising’ neighbourhood working – potentially breaking the link with local people, the knowledge and different ways of thinking they bring – and being overly reliant on people who are trying to support their community but at the same time balancing many other professional and personal needs.
• Performance management and targets. The centralised approach of the NHS to performance management and output measures does not always lend itself to projects focused on wider determinants of health, health creation and prevention. Particularly where diverse sources of funding are being used by a single organisation, reporting requirements can become a barrier to progress. These activities are likely to realise benefits in a much longer timescale, perhaps years in the future, compared to more acute delivery.  There were seen to be significant risks in heavy handed, overly frequent, or inappropriate monitoring that could stand in the way of or divert resources from encouraging participation and delivering on outcomes themselves. Attempting to fit local and hyper-local initiatives into broad national frameworks such as those for NHS performance management is likely to stymie the growth of effective joint working at a neighbourhood level. It could also inappropriately incentivise activity and funding, which if allowed to develop more organically around local needs would in time feed through in different and more positive ways into supporting overall system performance. 
• Existing infrastructure. Community infrastructure is a critical starting point for neighbourhood working and this creates a challenge for neighbourhoods with low levels of existing infrastructure to build upon. In rural communities there were issues with sparse transport infrastructure, while in urban areas access to affordable, convenient and shared spaces to meet is increasingly limited.  Overall, areas of high socio-economic deprivation tended to face more barriers in terms of historic underinvestment or lack of revenue support to create and sustain community assets, increasing the chances of such neighbourhoods being left behind.