Episode 19 - Neighbourhood working and the role of activation

Summary In this episode, Ollie and Tim explore the growing focus on neighbourhood working within the NHS and what it will take to make it meaningful in practice. They reflect on the current policy direction, which emphasises a shift from hospital-based care to community, prevention and more proactive support. While the ambition is widely supported, the conversation explores why previous attempts at neighbourhood working have struggled to deliver lasting change. They discuss how healthcare systems continue to focus on medicalised outcomes, linear change and organisational structures, rather than the relationships, behaviours and cultural shifts needed to truly transform care. A central theme of the episode is activation, supporting people, professionals and systems to build the confidence, knowledge and skills to take a more active role in health and care.  Tim and Ollie explore how health coaching and person-centred approaches can move conversations beyond advice-giving, helping people take a more active role in their own health. They also reflect on the reality of working in pressured systems, where burnout, limited capacity and competing priorities make change difficult. The conversation highlights the importance of protecting roles like health coaches, social prescribing link workers and care coordinators - as well as learning from the voluntary sector, which has long worked in this way. While the direction of travel is clear, making neighbourhood working successful will depend on sustained investment in skills, mindset and relationships. Takeaways Neighbourhood working has been a long-standing ambition but has been difficult to implement in practice. Structural change alone is not enough - relationships, culture and behaviours are key. Healthcare systems often prioritise medicalised, short-term outcomes over longer-term change. Activation is about building confidence, knowledge and skills across people, staff and communities. Person-centred conversations can change how people engage with their health and care. Workforce wellbeing and capacity are critical to enabling meaningful change. Voluntary and community sectors have long led the way in this approach. Measuring success in neighbourhoods requires looking beyond traditional clinical metrics. Long-term change requires patience, trust and investment in relationships. Small changes in conversations can have a significant impact over time. The success of neighbourhood models will depend on how they are delivered, not just how they are designed. Further Reading The latest guidance on neighbourhood working from the Department of Health and Social Care: https://www.gov.uk/government/publica... Commentary on the neighbourhood health framework from The King's Fund: https://www.kingsfund.org.uk/insight-... A longer read from The King's Fund exploring what neighbourhood health means in practice: https://www.kingsfund.org.uk/insight-...