Neighbourhood health: from system ambition to community reality

Across England, there is a shift towards neighbourhood health, with the aim of moving care closer to communities and tackling inequalities. On paper, the vision is compelling. In practice, however, many neighbourhood models are falling short of their potential.

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NAVCA's new report, grounded in the lived experience of NAVCA member local infrastructure organisations (LIOs), and ICS-VCSE Alliances, shows why. Too often, neighbourhood working is shaped by system boundaries rather than community realities. VCSE organisations are brought in late, funding is short-term and unstable, commissioning remains complex and exclusionary, and community insight is undervalued. The result is neighbourhood working that improves coordination within the system but misses the opportunity to build long-term community health and resilience.

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Where LIOs and VCSE leadership are properly supported, the difference is clear. Trusted local infrastructure connects organisations together, so people get the support they need earlier. It makes sure support reaches those furthest from statutory services, enables trauma-informed and culturally competent approaches, and brings real community intelligence into decision-making. Neighbourhood health works best when it is powered by relationships, trust, and lived experience — not just structures.

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So, what needs to happen next?

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1. Build a shared local understanding of neighbourhood working.

Partners across health, local government and the VCSE need a clear, co-designed understanding of what “neighbourhood” means locally, rooted in how communities define place, not just administrative boundaries.

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2. Set out a roadmap for VCSE involvement.

Local VCSE input must be explicit across neighbourhood, place and system levels, with LIOs supported to coordinate engagement and ensure diverse voices shape priorities and delivery.

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3. Improve communication with LIOs and ICS-VCSE Alliances.

Consistent, two-way engagement is essential to ensure community insight informs strategy and decision-making at every level.

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4. Make investment multi-year and flexible.

Short-term, stop-start funding undermines trust and impact. Stable investment in both VCSE delivery and local infrastructure enables prevention, innovation and continuity.

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5. Align neighbourhood health with local economic development.

Investing in VCSE-led neighbourhood working strengthens local economies, builds social capital, and tackles the root causes of poor health.

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6. Recognise LIOs and Alliances as strategic leaders in prevention.

Their networks, convening power and insight make them essential partners in early intervention and community-led health creation.

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7. Reform commissioning to enable equitable access.

Simpler, proportionate commissioning — including grants and collaborative models — is vital to enhance the contribution of smaller, local VCSE organisations.

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8. Invest in shared intelligence systems.

Community-held insight must sit alongside clinical and system data, with two-way data flows that inform neighbourhood plans and strategic commissioning.

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Integrated neighbourhood working represents a real opportunity to do things differently — but only if systems move beyond rhetoric and root in communities. We need to move beyond systems, and invest in the convening, coordinating, and relationship-building work of local organisations that make community-led health possible. Local infrastructure organisations are not an optional add-on; they are the connective tissue that turns ambition into impact.

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Download your copy of the report here.

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