King's Fund: Unleashing the power of communities
Unleashing the power of communities: why neighbourhood health must be neighbourhood-led not just neighbourhood-based
Seven years ago, the community of Fleetwood made a bold move. They bought their long-abandoned community hospital through a new charity, The Fleetwood Trust. What has happened since offers a powerful vision for the future of neighbourhood health that goes beyond simply moving services closer to home.
Rejecting the idea of recreating a conventional health centre, Fleetwood Trust has been led by two principles. First, letting the community decide what happens in the building and then collaborating closely with it on delivery. Second, providing a genuinely holistic and preventive range of services and activities that cater to the wider wellbeing of Fleetwood’s residents, recognising the intimate relationship between health and people’s connection to community, place and purpose.
The result? A space that offers health care such as outpatient and child and adolescent mental health services but also a lot more besides: youth work, employment support, a food bank, sport and exercise classes, police liaison, office and meeting space for the voluntary and community sector, digital training, art classes, exhibitions – the list keeps growing. And at the heart of it all – a vast cafe owned by the community serving great coffee and food, run by a local social enterprise and staffed by people with learning disabilities. Fleetwood’s hub is more than a building; it’s a place where people can feel valued, connected and supported. As one resident described it, ‘every visit is like being given a big cuddle’.
The power of people
Fleetwood’s vision exemplifies the idea that neighbourhood health doesn’t just mean neighbourhood-based, it means neighbourhood-led. So it was hugely encouraging to see this principle reflected in the 141 proposals bidding to join Wave 1 of the National Neighbourhood Health Implementation Programme.
Those bids reflect a growing awareness that current conventional models of care that do things to people rather than doing things with them are no longer sustainable. With shrinking resource and growing demand, there is no option but to augment public sector effort with the energy, assets and insight offered by individuals, families and communities. That requires a deep collaborative effort that not only engages patients and residents in decision-making but transforms how we conceive of care moving from a traditional medical model to a biopsychosocial approach that treats the whole person and recognises the strengths they and their networks can bring to creating and maintaining good health.
The evidence shows us it’s a shift that delivers.
Take Westminster’s Community Health and Wellbeing Workers. By collaborating closely with people in the community to provide trusted, holistic health support to the 20% most deprived neighbourhoods, the NHS in those areas has seen A&E and hospital admissions fall while preventive initiatives such as vaccinations, health checks and cancer screenings have all risen substantially.
In the Scottish Borders, the Community-Led Support initiative has brought together social workers, health care providers and local community organisations to create safe spaces in a familiar environment, where people drawing on social care can discuss their needs and hopes and receive a tailored response, often resulting in connections to non-statutory services. As a result, adult social care waiting lists have been cut radically.
The science backs up the approach. Research shows that when people feel safe, valued and connected to their community, it reduces chronic stress and associated negative coping behaviours – key factors in the development of many health conditions. When individuals experience a sense of belonging, it shifts their emotional state from one of anxiety, demotivation and sedentary behaviours to one of control, resilience and wellbeing. This shift helps to reduce chronic inflammation, enable more effective prevention, and reduce the risk and progression of many chronic diseases.
Catalysing neighbourhood-led health care
To secure this shift to neighbourhood-led health care, we will need to focus on four key areas at local and national level:
Sharing knowledge: the principles and practices underpinning the initiatives in Fleetwood, Westminster, the Scottish Borders and many other areas need to be understood and shared systematically across the country.
Looking beyond the NHS: partnerships across the public sector, VCSE and communities need to be developed to provide the integrated, holistic care that should be at the heart of neighbourhood health – this effort can’t be restricted to the NHS.
Local innovation: the enormous potential for creative, impactful change present on the frontline of services and in communities needs to be encouraged to flourish as part of the shift to neighbourhood health.
Sustained change: we need to ‘hard wire’ the changes by ensuring that funding flows, contracts, regulation, policies, data and technology, and other enablers support collaborative, neighbourhood-led solutions.
A healthier, happier future
Not everywhere is going to be able to replicate Fleetwood’s Community Hub overnight. And nor should it. What works in Fleetwood may well not be right for other places. Context is all and if we are serious about being neighbourhood-led then those neighbourhoods will inevitably choose the route that’s right for their needs.
But what every area can embrace is the principle of neighbourhood health as a catalyst for the profound change we need in how we do health and wellbeing across the country. A change that lets the NHS, other public services, the voluntary sector and communities work together as equal partners to keep people happy and healthy where they live.