Realising neighbourhood health – thinking and funding differently
Making neighbourhood health work for people and communities
Authors: Charlotte Wickens and Cassie Staines.
But what is getting in the way?
We know that while there is fresh impetus to deliver neighbourhood health now, this is not a new ambition and in fact echoes a long-held vision of ‘care closer to home’.
This has proved difficult to spread and scale, despite the commitment of successive governments and broad support across the health and care system.
This leaves a question about what is preventing the realisation of the shift from reactive, hospital-based care towards community and neighbourhood-based approaches.
Macmillan’s work as a partner to systems looking to work differently and our work to generate insight into the ongoing development of neighbourhood health has made it clear that, among other things, there is definitely a question about money. In the context of stretched budgets across the whole public sector, alongside a strained financial landscape for the NHS with underlying deficits and stretching efficiency targets, additional funding to support the ambitions around neighbourhood health is very limited.
But in our interviews with a range of stakeholders, from system leaders delivering neighbourhood health in different parts of the country to policy, we heard that this was not just about a lack of resource.
In fact, it reflected the lack of flexibility and difficulty in moving money around the system to be able to invest in transformation.
This means there needs to be more than just funding available to underpin the transformation to a neighbourhood health service, but also the financial architecture that enables this to be a sustainable change.
“You need to use the resources that you've got flexibly, so I suppose that would be another enabler is, you know, a willingness to be innovative, take a risk, be flexible”.
Doing transformation differently - Macmillan’s experience
This chimes with our experience at Macmillan. We are one of the leading organisations testing how outcomes‑based investment can support the shift from hospital to community care. We are partnering with systems providing upfront social investment to help design, test and embed new approaches to care.
Social investment is a way of funding services that supports long-term change by providing upfront, interest free funding to help partners develop and deliver new models of care. The funding is repayable only if agreed outcomes are achieved, and repayments are capped at the cost of delivering the service. This approach allows partners to develop sustainable, community-based services while sharing risk and building evidence of what works.
“And in a system with like 0 spare revenue, it provides that opportunity to start to move money around the system in a way that reduces risk for the NHS”.
For over a decade we have worked with Social Finance, a not-for-profit organisation, to design, test and embed new approaches to end-of life-care which has seen us partnering with the NHS and hospices.
To date, through the Care and Wellbeing Fund and the Macmillan End of Life Care Fund, we have launched 11 services which have supported more than 6,000 people, reduced time spent in hospital by an average of 14 days in the last year of life and avoided over 86,000 unplanned hospital bed days.
This approach has proven that social investment can support new types of partnership between charities and the statutory sector which helps systems to re-allocate resource from unplanned to planned care with greater focus on outcomes and patient experience.
We are now investing £250m over the next 3 to 4 years into neighbourhood health across the UK through our Neighbourhood Health Transformation Fund - to identify what genuinely works, codify it, and help systems spread it at pace. We know this will have an impact on unwarranted variation, inequities in access to care, sustained acute pressure and the future sustainability of the NHS.
While the services supported by Macmillan’s funds look very different on the surface, they are testing a replicable, investable model – earlier identification, proactive care planning, strong MDTs, and proper wrap‑around support – and how that model can be adopted elsewhere.
Through the Neighbourhood Transformation Fund, this often means voluntary and community organisations playing a central role — not as an add‑on, but as an integral part of the model. Therefore, to strengthen the role of the Voluntary, Community, Faith and Social Enterprises (VCSFE) sector in local health and care systems, Macmillan has developed a separate Anchor Programme grant to provide direct funding to community-based organisations supporting them to act as equal partners in service design and delivery.
Going forward - building capability through partnership
Macmillan’s experience of social investment shows that transformation is not primarily about additional resource, but about giving partners across the health and care system the capacity, flexibility and support to think differently. As such, alongside delivery, we’re investing heavily in system capability – both to deliver neighbourhood health and to help systems become investment ready.
We know this capability building is crucial to developing models that are community‑ and provider‑led, supporting our partners, like West Hertfordshire, to do what works for their population, then help capture and spread that learning – rather than imposing a single model from the centre. Learn more about our work in this space.
Our National System Change team will be publishing a long read in the autumn which explores further the conditions that would enable a neighbourhood health service, with a focus on financial architecture and funding flows, and are carrying out interviews with a range of external stakeholders. If you’d like to talk to the team about this project please email the National System Change team.