Strategy Unit Neighbourhood Insights session — notes

Simon Morgan-Wilson

20 May 2026 • 4 min read

What can the NHS learn from neighbourhood working in other policy areas?

Intro / framing

NHS is developing neighbourhood health
There's a long, rich tradition of neighbourhood working in other policy areas to draw on (New Deal for Communities, neighbourhood renewal, Pride in Place, Big Local, Independent Commission on Neighbourhoods)
James Plunkett has been invited to talk about this

Two conceptions of "neighbourhood"

Neighbourhood as site of delivery
A more localised health service, smaller unit, closer to people, but the model is essentially unchanged. Service remains primary.
Neighbourhood as community in the lead
Communities of people put in charge of their own health - system becomes relational infrastructure, an enabler of an empowered, agentic neighbourhood

The second is much richer, has long history, and is a much bigger ask of NHS instincts

Why this matters: historical context

Original NHS institutions built for technical problems (clean water, railways, acute/communicable illness): diagnose, prescribe, treat
Shift over 20th and 21st century towards chronic and "lifestyle" conditions (anxiety, depression, diabetes, arthritis, ageing): a rise in complexity
Need to move from bureaucratic top-down system to a wellbeing service
NHS has even stronger bureaucratic, pathologising, hyper-specialised, risk averse culture than most of the state

What communities do by instinct (Big Local evidence)

Holistic: treat people as whole humans, not conditions
Relational not transactional: cup of tea, not 15 minute appointments
Resourceful: spread modest resources wide
Positive/asset based: start with strengths, dreams, what's loved about the place
Preventative by nature: walks, aerobics, knit and natter circles
Communities start where public services struggle to get to

Five principles of genuine neighbourhood led work

Civic Rewilding report

Use power to hold space open
Resist specifying deliverables, milestones, metrics upfront - create space and trust communities to fill it
Distributed intelligence (the octopus)
Citizens and neighbourhoods are themselves sites of intelligence. Practitioner becomes enabler, not central expert
Traction, not speed
Invest in relationships upfront. You appear slower but go faster medium to long term, especially on behaviour change
Spread, don't scale
Context is the power - you can't pluck the flower from the soil. Recreate conditions in other places - let people adapt, learn, grow their own version
Cultivate governance organically
A trellis around the work, not pre-built scaffolding. Governance grows from the work and often outlasts it as new local capacity

Test, Learn, Grow

Cabinet Office initiative: mixed discipline teams at the edge of the system, learning their way into complex problems and driving change up
Same spirit as neighbourhood led work: decentralised, distributed intelligence, mixed disciplines

More info on Government Outcomes Lab

Q&A points

Technocracy and relational approaches together

Not either/or - a spectrum of problems. Heart surgery sits one end, loneliness the other
Misapplication is the problem: piloting a "loneliness intervention" brings the wrong mentality
Digital can enable the relational: e.g. automating GP note taking so the clinician can look the patient in the eye

Evidence and analysis

Implicit hierarchy still puts randomised controlled trials (RCTs) on top, conversations at the bottom
For context dependent work, RCTs have low external validity
Broader repertoire now: implementation science, theory based evaluation, iterative/prototype led methods, social practice (visiting, convening, tacit knowledge)
Family Nurse Partnership as cautionary tale: worked first time, codified and scaled, later trial showed no statistically significant effect. Context was the active ingredient and got stripped out

Methods on the ground

100 Day Challenge (time-boxed ideation with communities)
Living Well (mental health transformation in several places)
Relational practice: Camden's centre, the Relationships Project syllabus
Asset-based community development (20–30 years of practice, well evidenced)

Examples worth looking at

Scottish Borders care waiting list: 600 down to 100 through person-to-person conversations
GM Live Well: combined authority creating space for preventative approaches
Hastings (pier), Plymouth, Grimsby (15+ years of community empowerment, employee and patient owned mental health services in NE Lincolnshire, democratically elected leadership)

Funding and commissioning

Old answer: speak the system's language (social return on investment figures, invest to save). Savings rarely cashable, pressure just relieved
Newer answer: push back on demand for upfront certainty - it crowds out the space good work needs
More agile finance: small bets, portfolio of community led initiatives, redistribute as you learn what works. Closer to how contemporary tech sector funds

Optimism

Direction of travel very clear: "wicked problems" literature is over 50 years old, methods 20+ years mature
Worry is pace: systems under fiscal and political strain, public losing patience, connection to rise of extremism
Political intent now there (Pride in Place money, push for neighbourhood healthcare). The machine runs deep and struggles to shift

Closing thought

"People have more freedom than they realise." Agency exists - seek forgiveness not permission.

After thoughts: How this (could) relate to my NHS-E work

Two conceptions tension applies to the NHS App.
Surfacing appointments could just be "service delivered in a smaller container" (transactional booking, faster) or it could enable people to manage their own health more agentically across - for example - pharmacy, dentistry, optometry, screening.
The complexity shift cuts through Referrals and Appointments.
Acute care fits diagnose/prescribe/treat. Community pharmacy, screening, optometry sit closer to the chronic/preventative end where relational matters. Are these non-acute settings exactly where the technocratic model is weakest, so booking journeys need designing with that in mind, not just for transactional efficiency?
Hold space open versus aspirational delivery framing.
The ongoing iteration between top-down aspirational framing and a discovery/alphas's evidence-based approach = "resist upfront specification".
The test ICB as soil, not pilot.
"Spread, not scale": The system instinct will be to treat wherever we "land" as a pilot to replicate. Plunkett argues understand the conditions that make it work there, then help other places grow their own version. Frame it as first-of-type, not a template.
Distributed intelligence and local advisory voices.
Whichever ICB and clinical advisory group we work with aren't a gate to pass through: they are a site of intelligence. Same goes for frontline pharmacy, optometry, dentistry colleagues. Always worth checking how much of the design actually starts from their knowledge versus arriving already shaped.
Traction over speed.
Useful counter to pressure for visible delivery. Time spent on relationships with any test region, with internal teams working on tech system integration(s), and with internal leaderships = traction building, not delay.
Test, Learn, Grow alignment.
Isn't this just doing an alpha? Worries: finance and governance.
Evidence beyond the RCT model.
A good discovery could, should move in this direction: qualitative across many services, teams, documents etc. The Family Nurse Partnership example could be a useful story for "any proof this scales?".
Governance as trellis.
Useful lens on the relationship between the team, any wider programme(s), any cluster structure, and tech platforms. Is it possible to get/let governance grow around the work rather than fitting work into the existing (even forced) structures?
Agency.
There's more freedom than the/any system suggests.