Making Neighbourhood Health A Reality – Podcast 

Neighbourhood health has long been a shared ambition across the NHS and its partners – but turning that vision into reality requires more than new structures or service models. It demands trust, leadership, and the space for teams to work differently. In this episode, NAPC Senior Leader Dr Johnny Marshall, sits down with NAPC faculty member and NNHIP coach Andy Mullins to explore what the National Neighbourhood Health Implementation Programme (NNHIP) really looks like on the ground. 

Drawing on learning from 43 sites across England, Andy reflects on what’s driving meaningful progress – from building multi‑agency relationships and supporting the “squeezed middle”, to balancing bottom‑up energy with national direction. Together, they unpack why neighbourhood health is fundamentally about ways of working, not contracts; why communities must come before services; and how leaders at every level can create the conditions for lasting change. This practical and hopeful conversation offers valuable insights for anyone involved in delivering neighbourhood health locally. 

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Transcript

Introduction

Johnny

Welcome to this NAPC Live. So over the next 30 minutes, we want to explore something very practical in terms of what the National Neighbourhood Health Implementation Programme actually is. I’m going to start calling it NNHIP, just to shorten the number of words I have to use. More importantly, I guess, what we’re learning about it in the hope that will be very practical and real for you on the ground. And This is very much about implementation, thinking about what happens when neighbourhoods’ health moves from aspiration into reality, but also recognises that you will have a whole load of insight and value to add to neighbourhoods. It’s not all wrapped up in the national programme and important that we’re understanding how we connect all of those dots together.

So by the end of the session, I hope that you’ll understand what the NNHIP programme is all about. You’ll have insight into the learning from it. And then perhaps as a group of interested people, NAPC membership working together, we’ll have a clear understanding of how we might support all of us in being able to deliver this more effectively locally. But let me start by introducing Andy Mullins. Andy is a member of the NAPC faculty and delivering part of the Neighbourhood Health Implementation Program At a local level, he’s one of our coaches. He has a wealth of experience in coaching and supporting people, do great stuff at a grassroots level. So welcome, Andy. Great to have you on board.

Andy

Thank you, Johnny. I would say I don’t appear here today as an expert because there are, I’m just looking at all the names of some of which I recognise coming, joining the call;there’s plenty of experts on this call. I think, this is all about learning together, isn’t it? And which is what the programme’s about, really.

What is the National Neighbourhood Health Implementation Programme (NNHIP)?

Johnny

Let’s start with, I guess, not so much the elephant in the room, but what is the National Neighbourhood Health Implementation Programme.

Andy

I’m glad you said it in full, because it is a bit of a mouthful. And yeah, let’s just stick to NNHIP. So NNHIP is essentially it’s a coaching and peer learning programme. And it’s all about aimed at accelerating the development of neighbourhood health, a key feature of the 10 year plan, of course, across 43 sites in England that were successful. They went through an application process to join. And we work, at NAPC, we work really closely with our partners on the program. It’s been going for about six months now. And I would say every single site has made progress. And most of them are able to demonstrate some real impact now from the episode. So it’s really exciting.

Johnny

And what sort of support are people getting at a local level?

Andy

They might get somebody like me supporting, working with a local coach, and that can be really flexible. So we’ve all kind of sat down with local coaches in our own systems and said, where are you at? What do you need from us? How do we adapt and support? So it’s a very much kind of an adaptable program, but we are big on sharing the lessons learned from on the 43. We put a lot of infrastructure in place around helping people to learn the lessons, what’s working well, what’s not working so well, what are some of the barriers, helping us to figure out what are some of the national enablers that we need to be working on in order to support the sites. So from local to national.

The “Loose-Tight” Approach: National Direction and Local Flexibility

Johnny

I think it’s one of the things that always slightly concerns me about our national programme. is often there’s a sense of it broadcasting in one direction. So perhaps from the national centre out to the system in terms of, you know, this is what we would like to see, this is the model that we have anticipated you will all end up creating. What does the balance feel like between that sort of, you know, that national broadcasting and actually perhaps sort of creating a shared narrative that really makes sense at a local level?

Andy

Yeah, Johnny, it’s a good question. And I recognise the tension and I am sure that those listening in are familiar with that kind of tension, not just in neighbourhood health as a topic, but in other topics too. But I guess what we’re trying to do is balance, strike the right balance between that sort of bottom up emergent almost the social movement idea, because that’s where the momentum is driven.

If you can get the willingness of local teams working on this and engaged, that’s where we spin the flywheel of momentum. But at the same time, if we want to scale and spread the lessons, there is something about having that right balance for the top down too. So the program often talks about the loose tight side of this. Loose on how you go about delivering neighbourhood health, but quite tight on some important things if we’re going to learn, like evaluation.

So how do we measure, how do we share and how do we learn? That’s all tight stuff. But the loose bit is how you go about it locally. So I think, I mean, we’d have to ask all the systems, say whether or not we think we’ve got the balance right. I think it’s getting the balance right. But this is, I think at NAPC and our members at NAPC will be very familiar with this. our evolution, of course, has been in this space for the last 20 years.

This idea of whether it’s primary care home, becoming primary care networks, becoming integrated neighbourhood teams, now neighbourhood health, that kind of evolution. We started from that, the social movement idea of it. And this is a great opportunity to scale up on a national level.That’s why I think colleagues at NAPC and some of our members are really excited about this. But it is only the first few steps on a very tall ladder. So, you know, that’s what I would say.

Johnny

It sounds like NAPC has been on this ladder. Well, we have been on this ladder for a while, I guess, in terms of primary care home, thinking through how you might have a group of professionals working together around the needs of the population that are absolutely more attuned to that and have the right set of skills and therefore the right workforce delivering that.

And I think I’ve been wrestling a little bit in myself over the last sort of few months with why it’s been so hard to bring about this change. So I forget how old primary care homes are, but certainly more than a decade. And when they became a contractual NHS England organisational solution under primary care networks, it felt that we lost a little bit of the sort of the real ethos of what they were all about. So I guess where do you think we are in terms of the translation from maybe the principles we had in primary care home into understanding that actually these are the most important aspects of delivering at a local level rather than it being seen as another organisational solution?

From Primary Care Homes to Neighbourhood Health

Andy

I heard somebody fairly recently described neighbourhood health as at the heart of it, and I think this is true about primary care home as well, at the heart of it, it’s about multi-agency teams coming together to do the right thing for the people that they know in their communities. So doing the right thing for the communities, not necessarily feeling they have to do the right thing for the organisations that employ them. And I thought that was just a really lovely summary about what Neighbourhood Health is about.

And I think in that sense, the principles are very close to, if not the same, and build on what we were trying to do with primary care home. I would say, though, to your point about contracts and structures. I think there is always a risk that we try and codify and put structures around this too soon, too early. And what we know, and lots of people listening in will know that where there is a lot of success, people haven’t rushed to put a structure or a contract around it.

That fundamentally, this is about trust and relationships. Those areas that are making the most progress are the ones, not with the best structures, but the ones where teams know each other, they trust each other, they back each other. I guess they’re willing to experiment together and learn together. And that’s the basis of it, really.

Johnny

We get to sort of sense sometimes that neighbourhood health might be something that’s happening over there in the corner of the NHS, may not feel it’s quite central to maybe a chief executive of an acute trust, perhaps a slightly different or maybe quite significant different definition between one country and another or social care and health care. And I know from previous discussions that we’ve had about this sense of common purpose being a really important part of bringing about this sort of this human-driven change, I guess. What’s your sense on the ground about how common that purpose is and whether there people are finding ways of overcoming that when there’s a when there’s a perhaps more than just a natural tension?

Andy

So I think my starting point would be we are all neighbourhoods. So it is really easy to other neighbourhoods. It’s some team being set up over there. And if I’m sitting in a hospital, I might be saying, well, when are they going to start having an impact on my front door or my back door? I might say that. Or as I’ve been experiencing down here in Cornwall where I live, the hospital is saying, no, we’re every bit as much as part of the neighbourhood as the local authority, as the voluntary sector is, as community teams are, as primary care is.

And so those that I think are around the country, are maturing in a conversation, see this as so broad, even talking about local employers being part of this and contributing to the health and wellbeing of a population, that I think that’s probably where we need to get to.

One of the lessons for me is if we hear conversations that says, thinks about neighbourhoods as being something else, like what are they doing, then we know we’re having the wrong conversation. Should it be what are we doing to support our neighbourhoods? And that’s a mindset shift, which it sounds really simple to say, doesn’t it? But it is a big mindset shift for all of us. And so it’s not just about a medical model, it is the wider social determinants. And we’ll talk a little bit more about later, but you know, the left shift, yes, we talk about in their 10-year plan, we talk about possible to community. Well, the real shift and the long-term impact is more about what matters to people in their communities. But we’ll come on to that a bit later.

Why Leadership Is the Foundation of Neighbourhood Health

Johnny

So from the work that you’ve been involved in, what do you think are some of the key learning that’s emerging from NNHIP that actually would be valuable for people to then be applying in their own sort of local settings?

Andy

Yeah, Johnny, I guess, and it will probably be different in different, with different systems, but there are some emerging themes. And for me, we talked about this is fundamentally about building trust and relationships. That doesn’t just happen, does it, of course, but the foundation stone of trust and relationships comes from leadership. So this is fundamentally about how do we help our leaders, support our leaders at all levels in systems, create the conditions that allow teams to be at their best, multi-agency teams to be at their best, to be working across organisational boundaries and be thinking about how do they best support the populations that they serve.

So it’s not a service model. I often hear that question, or people say, well, what’s the service model? We can’t possibly start on this until we’ve defined and then commissioned the service model for neighbourhoods. That’s the wrong, if we’re hearing that as well, we should just pause and say, no, it’s not a service model. This is all about ways of working and models of behaviour. So we do need to think about how we shift, how we lead, It’s not just about what we do.

So those systems that I think are getting more and more mature as I think about neighbourhood health are thinking about how do they develop the leaders of the future to be able to be working collaboratively, having multi-agency, single leadership teams over a neighbourhood, all the way up actually to boards. You know, what are our boards doing to support and create the right conditions in neighbourhoods for them to be successful.

One of the other lessons I think we’re learning about this and the leadership challenge is that people often, I don’t know whether I really like the term, but Barry Oshery, who does a lot of work on systems thinking, he talks about the squeezed middle. So often the barrier to change is we find it in the, top of the organizations get it. All the execs are on board and they’ve got a bright ambition that everyone’s excited about. And when you talk to frontline teams, they get it. They get it really quickly, actually. But the challenge often are the people in the middle who on the one hand have been told they’ve got to report on progress and deliver organizational objectives, as well as lead and inspire the frontline team.

And therefore, what you end up getting is this squeezed middle who are thinking, well, hang on a sec. You want me to do all of this, provide assurance on the old model, and you want me to lead to the new model. And that’s the group of people that we need to lean in and support. They’re not a barrier. But what they are, the key enablers of this. And so systems really need to pay attention to what we need to do to support them.

Why Transformation Is Hard to Sustain

Johnny

So that really resonates with something I’ve been reading recently. I’m so troubled by the fact it’s so difficult to bring about transformation in public services. I’ve dived into the depth of Canadian research that talks about how difficult it is for an emergent system to sort of to be built from a dominant system because invariably, even though everyone thinks it’s a great idea, it gets seen through the dominant system lens and it just keeps getting dragged back. And presumably because although the chief execs might get it, actually the way the system is structured, it’s not a people thing.

The system drags the sort of those responsible for implementing it back into the old dominant system and everything that we measure. And that actually, the thing about this emergent space is it’s quite uncomfortable. When people feel uncomfortable and they don’t feel very safe, they end up falling back to what they know. I think much of what you said about trust and relationship, I guess I’ve heard that for like 30, 40 years, yet still we’re still talking about it. So do you have an example of how the approach that you’re describing has been implemented and has led to something positive that they’ve been wrestling with for a long period of time. But essentially it was about this holding this discomfort and the support people had or gave each other to be able to do that.

Andy

I had an image in my mind as you were describing that, of a kind of a rubber band. And I suspect systems are a bit, well, people are a bit like rubber bands, aren’t we? tend to snap back to what we prefer, what we’re comfortable with, and systems are exactly the same. And I guess what I What I’m seeing in systems that are making, are really breaking through some of this is that they sit with that discomfort as you describe, that they, and that’s hard, isn’t it? Particularly in the environment when we’re all under pressure financially from a performance perspective and so on, that’s a really hard space to be in. because we know that to make progress, we know that the momentum is the way in which we get progress.

But that’s not necessarily the impact that a board might want to see. if the questioning is all about, gosh, when are you going to have an impact on the front door of a hospital or the back door of a hospital, then if those are the questions that we’re asking at senior levels, then those are the behaviours we’re going to drive. We’re going to drive a focus on those two things, which might not necessarily lead to the biggest and longer term impact. We talked about that left shift earlier. I was reflecting, as you were just describing that, you know, one of the lessons we’re learning from the programme is we need to start with communities, not services. So we need to be asking our communities what matters to them.

And you know, whether that’s, I mentioned earlier, housing or loneliness or well-being, It’s not all about clinical pathways, although a lot of it will be about clinical pathways too. And so that’s where the biggest impact lies in all of this. That in itself will feel very uncomfortable for system leaders. So the question for them in their own leadership, I think, is what key lines of inquiry are you going to pursue in order to drive the right behaviours that leads to the biggest impact? And that key line of inquiry is not necessarily going to be what impact have you had on the front door of the hospital?

Although that might be important, is important. But it might also be how are you engaging with the local authorities if you’re in the health service? How are you engaging with the voluntary sector? How are we reaching out into the broader, wider determinants of health?

Because we know, and all the evidence says But longer term, maybe not this winter, maybe not next winter, but longer term, the only way we’re going to bend the curve on demand for healthcare is by focusing on those things. So we’ve got to hold that difficult tension about what can we do short term with what can we do long term. And the really exciting thing I think about NNHIP and the program is that there are areas that are beginning to show real impact even in the short term for on healthcare utilization. And but the really exciting thing is what they’re going to be showing longer term as well. So yeah.

Johnny

I guess I’ve heard you talk about very practical examples where people have been wrestling with challenges in camps, for example, over many years. And finally, they put the professionals in a room together and within about 10 minutes, just by talking to each other, they sort of they overcame the barrier and came up with a solution. I guess it’s that sort of thing that.

Andy

Oh, you’re right. Yeah, No, you’re right. And it happens, and it’s happened to me just recently where the answers are in, the answers are with our teams, aren’t they? You know, it really, it’s really, it’s It’s so obvious when you think about it, but we don’t do it. We don’t create the time and space, the headspace, just to get people together. But when we do, it’s extraordinary how much progress people make, because the common, people have a common purpose here. And nobody in our industry, our sector, goes in to work in the morning to make, to frustrate our colleagues and to make things difficult. We don’t. So if you can find a way to break through it, frontline teams do. Bring them together, that’s what will happen.

Investing in Teams: How to Unlock Bottom-Up Energy in Neighbourhood Health

Johnny

I guess one of the challenges is if you’re trying to unleash that bottom-up energy, it’s people having the energy bottom-up to get involved. Because everyone, certainly from our members’ perspective, we’re increasingly hearing that they’re under a lot of, so much pressure, I guess, just with the with the day-to-day activity, it’s difficult to find that space. You might imagine that those areas that are contributing to the national programme might be the most willing or have some space, but what do you think the lessons are for how you unlock that bottom-up energy when feeling people are under so much pressure on their day-to-day sort of roles?

Andy

I think you’ve got to turn it into a virtuous cycle. And You do have to invest in giving teams headspace. Don’t throw teams together, reorganise them, align them to neighbourhoods, expect them to become, you know, what Michael West would call real teams, because they’re going to end up with pseudo teams and their performance will decline. The only way we’re going to deliver neighborhood health is if we invest in teamwork, we create some headspace to allow people to come together, that requires some money.

And it’s interesting, you notice that we’re not very good at investing in ourselves in the NHS sometimes, or in the local authorities. So how do we create that space? So it’s really important that systems do that. I would say also don’t underestimate some of the basics. So this is about how do we enable people to share data, what are the digital tools and technologies that can free people up, can remove some of the barriers, using a single system, all those sorts of things. And in some ways, it doesn’t matter where you start. You’ve just got to start. And in my experience working with teams, whether it’s primary care homes or now in neighbourhoods, is over the years, is consistently, when you bring teams together, they will identify areas to free up space, free up their own time.

And that in itself then leads to better productivity, better morale, and even more time to focus on the things that they think are important. The encouraging thing for me is I think this is really a hopeful message for this program. It’s, you know, it’s already working in pockets. Just about every system in the country can demonstrate how it’s working. And the challenge for all of us, particularly NEPC members, is how do we back it now and how do we connect it and how do we help it grow?

Closing Reflections

Johnny

Great. Okay, final sentence. Are you more optimistic now than when you started the programme and why?

Andy

Yes, and because I can see some real movement nationally and when we talk to our members, the movement’s happening. Systems are beginning to get it, that this isn’t just about primary care as perhaps it might have been seen or viewed as in the past. This is a whole system approach. And I’m going to say it again, because all we should is this is about local authorities and voluntary sector as much as this is about healthcare. So yeah, that would be mine. So yes, I am positive always.

Johnny

Great. Thank you, Andy. That’s a great note on which to end. Thank you so much for your time. Thank you everyone for tuning in and listening. Watch out for your NAPC newsletters showing how you can get more engaged. And if you’ve got any queries, questions, please don’t delay to put them in the chat or send them into an APC and we’ll do our very best to pick them up for you. So thank you for your time. Great to see everybody. Hope you enjoy the rest of your day.