Everybody Needs Good Neighbourhoods

The Prime Minister’s 10-Year Health Plan is meant to mark a bold moment for the NHS in England — and for the beleaguered Labour government. It is intended to achieve not just incremental improvement but a “seismic shift” in the way healthcare is delivered: from hospitals to neighbourhoods, from analogue to digital and from treatment to prevention. At its heart is the creation of a new Neighbourhood Health Service, a model that aspires to bring joined-up care directly to people’s doorsteps.

It’s a powerful narrative. One that resonates with long-standing calls for a more local, relational and preventative health system. And one that could, if realised, represent the most meaningful transformation of the NHS since its creation in 1948.

The launch of the 10 Year Plan was also meant to be be a valedictory moment for the government on it’s first anniversary — much needed after the Prime Minister’s embarrassing climbdown on welfare reform.

But if we’ve learned anything from 40 years of public service reform, it’s this: creating strategies is easy; real system change is hard. The problem in British government is rarely the ambition. It’s the follow-through. And too often, bold visions drafted in Whitehall are worn down by complexity, capability gaps and the gravity of the status quo — as well as the odd referendum.

So the question is not whether the plan is right. It’s whether we have the courage and means to make it real. And whether we see neighbourhoods not just as sites for service delivery but as engines of renewal.

From Mission to Plan: A Tale of Two Visions

In theory, the 10-Year Plan released by the new Labour government should make real the bold Health Mission it campaigned on: fewer lives lost to the biggest killers, better access and a fairer Britain where everyone lives well for longer. In practice, alignment seems partial and uneven — but some of the delta reflects the harsh realities of governing and the hard choices that are made once in control of the reins of power. The UK’s economy remains in the doldrums following the financial crisis and Brexit. Simple arithmetic dictates there is less funding for public services.

Yet Labour’s Health Mission was activist, redistributive and focused on outcomes and it is disappointing that a hard dose of realism seems to have swept it aside. No doubt the fiscal situation compounds the problem.

The Health Mission offered ambitious and unequivocal goals though, like halving the gap in healthy life expectancy and cutting preventable deaths from cancer and heart disease. It promised to move from a National Hospital Service to a Neighbourhood Health Service, shift investment upstream to prevention and double the community workforce. It was underpinned by a Mission Delivery Board and a dashboard of indicators. It has been woven into the devolution agenda by the announcement that the mission will be run from Leeds.

The 10-Year Plan, by contrast, feels somehow less concrete and certainly less radical. It gestures at many of the right ideas — digital transformation, population health, workforce reform but any detail on ‘how’ is ominously absent. As NHS England chief executive Sir Jim Mackey said, it is designed to create “energy and enthusiasm,” not detailed guidance. That may be politically defensible. But we must also be honest: this is not yet a plan. It is an ambition.

Good Neighbourhoods, Good Friends

Both the Health Mission and the Plan place neighbourhoods at the heart of health reform. This is the right call. Health is shaped in communities, not clinics. Access, trust, prevention and continuity all flourish when services are delivered locally by teams who know the population they serve.

The Plan proposes a Neighbourhood Health Service built around new Neighbourhood Health Centres (NHCs), staffed by multidisciplinary teams including GPs, nurses, pharmacists, mental health workers and community health workers. These centres would co-locate diagnostic, post-operative, rehab and social care services, with extended hours and a digital front end. In fact, the at yesterday’s launch; the PM spoke from one such NHC in Stratford.

But co-location is not integration. The Plan risks conflating the two. Real integration means joined-up budgets, shared outcomes and unified governance. It means care navigators who don’t just refer across silos but accompany people through their journey. It means planning that reflects the actual geographies, experiences and realities of care.

There is little detail in the Plan about how integration will be achieved — it is a plan without a plan in that respect. However, nor is there a compelling offer on how neighbourhood teams will be supported, incentivised or held accountable. Most worryingly, the Plan says little about neighbourhood governance. Who leads these teams? How are communities involved in their design? What role will elected leaders or ICSs play?

Angela Rayner’s wider commitments to multi-year funding settlements, coterminosity with strategic authorities and a reformed approach to local audit and accountability are helpful signals. But until the health plan aligns with these broader governance reforms, neighbourhood working risks becoming a branding exercise rather than a functional shift.

As the Independent Commission on the Future of Neighbourhoods has argued, we need a default setting that starts with neighbourhoods, in service design, in funding flows and in democratic accountability. The Neighbourhood Health Service must be built with and for communities, not simply delivered to them.

Relational Public Services, A Relational State

There is a deeper opportunity here that the Plan only hints at: to move beyond transactional service delivery and towards a more relational model of public service. We’ve had a 40 year consensus that public services should marketised, commissioned, contracted, managed, measured, and evaluated — underpinned by the principles of New Public Management beloved by Thatcher and her successors. It has generated a generational challenge that has put competition, not collaboration at the heart of public services leadership; to our detriment.

Yet, the idea of relational services is not new. We have seen their power in early years programmes, family support teams and trauma-informed models in social care. They require time, trust and continuity. They value human connection over throughput. They rely on empowered frontline professionals and systems built around people, not protocols.

The Neighbourhood Health Service, done right, could be a vanguard of this shift. But that requires more than co-location. It demands cultural change, workforce reform and new approaches to measurement, funding and accountability. It also requires a fundamental shift in central–local relations: less performance management, more distributed leadership.

This isn’t just a health challenge. Complex public service issues cannot be solved through a single organisation’s lens. Health outcomes are shaped by education, housing, employment, justice and environment. Joined-up services require joined-up governance. This is why Labour’s Health Mission rightly called for health in all policies, a cross-government delivery board and strategic alignment across Whitehall — yet that seems to remain elusive and the Missions, intended to drive this shift, seem to have run out of steam.

The 10-Year Plan must now be followed by an equivalent commitment to system reform. The language of partnership must be matched by real power-sharing — over budgets, data, design and decision-making.

Prevention as the Litmus Test

The Plan contains some promising moves on prevention. The focus on genomics, population health management and self-care via the NHS App is forward-thinking. The expansion of the Genomic Medicine Service to identify disease risk and target interventions is ambitious and potentially game-changing.

But this is a clinical model of prevention. It is focused on individual risk, not population-level determinants. There is little in the Plan about structural inequality, upstream drivers or the social determinants of health. There is no mention of housing, food insecurity, environmental risk, or the role of planning and transport.

Labour’s mission promised to embed health in all policies, bring back Sure Start, and make England a Marmot Nation. The Plan does none of these things.

If we are serious about prevention, we must act on housing, air quality, employment, food policy and early years. That means a cross-government strategy, not just a set of NHS programmes. I’ve written elsewhere about the 5th Industrial Revolution and that lens demands we go further: using data and design to proactively address root causes, not just predict clinical risk.

We must also change what we count. Unless we measure prevention spend, track uptake of early interventions and hold systems accountable for long-term health outcomes, prevention will always come second to activity targets. This is all absent from the 10 Year Plan.

Prevention is not an add-on. It is the organising principle of a modern, sustainable health system. And it requires whole-of-government action, backed by metrics, funding and leadership.

The Workforce is the System

The most significant gap in the 10-Year Plan is workforce. Labour’s Health Mission proposed 7,500 more medical school places, 10,000 new nurse and midwife training spots, and doubling the number of district nurses and health visitors. The Plan mentions none of this.

Instead, it focuses on management capability, leadership development and talent pipelines. These are welcome. But they are not enough.

A Neighbourhood Health Service cannot exist without a community-based workforce. That means care navigators, community pharmacists, occupational therapists, school nurses and carers with career paths and pay structures. It also means tackling retention, burnout and overregulation and under-support as well as dealing with the deep seated cultural and behavioural issues that have built up in the NHS over decades. It is also an opportunity to create jobs of the future in those communities.

We will not deliver relational care with a transactional workforce model. We need investment in time, trust and teams.

Technology is Not a Shortcut

The Plan is at its boldest in its digital ambitions. From a unified Single Patient Record to AI scribes, ambient transcription, virtual-first triage and self-referral, the digital offer is sweeping and, in some respects, transformative.

But ambition must be tempered by realism. Technological change in the NHS has been slow, uneven and often poorly implemented. Many hospitals remain paper-based. Electronic Patient Records took over two decades to roll out. Culture change lags behind infrastructure. Without deep investment in change management, digital maturity and procurement reform, this digital vision risks being as brittle as the old infrastructure it seeks to replace.

The Plan’s commitment to virtual-first care, self-referral and AI-driven triage is welcome. But it must not become a substitute for investment in access, relationship-based care and inclusion. Technology must serve human connection, not replace it — another facet of the 5th Industrial Revolution.

Digital transformation is not a procurement project. It is a people strategy. Clinicians must trust the tools, workflows must be re-engineered and patients must be supported to use new systems. Without investment in digital skills, infrastructure and inclusion, the NHS risks repeating past mistakes: big systems, big hopes, little change.

Technology can enable relational care — but only if it is designed with and for users. We must build for equity, usability and adaptability. And we must measure success in terms of lived experience, not just transactions.

Angela Rayner and the New Civic Contract

In her first major speech as Deputy Prime Minister, Angela Rayner made the political case for this new approach at the LGA Conference yesterday — not long after Starmer announced the 10 Year Plan. Rayner spoke not just of local services but of local power. She announced the end of competitive bidding pots, the return of multi-year settlements and the beginning of a new relationship based on honesty and respect — ostensibly unpicking the Cameron and Osborne era reforms that emasculated local government.

“Gone are the days of diktats from above,” she said. “It is time for those with skin in the game to be put in the driving seat.”

That sentiment should not just inform the future of local government. It should shape the future of health reform too. Because you cannot deliver a relational, preventative, community-based NHS while running local government into the ground. And you cannot build a truly human-centred health system without also empowering the places where people live, work and belong. That includes helping local government resolve one of its biggest problems, which is also a problem for our NHS — adult social care.

Rayner’s recent speech may be the most important contextual document for understanding how the Plan could evolve. She announced the end of short-term competitive pots, promised long-term funding certainty and committed to a new Leaders’ Council to embed local voices in national policy. These moves matter. They shift the centre of gravity from compliance to collaboration. They lay the foundations for relational governance: where the people with skin in the game shape decisions.

But they need to go further. Local government must be given a clear and consistent role in health planning and delivery. Neighbourhood governance must be co-designed, not assumed. And place leadership must be backed with fiscal power and institutional support.

The Neighbourhood Health Service could be the beginning of a new civic settlement: one that rebuilds the relationship between citizen and state. But only if it is co-created, not centrally dictated.

Conclusion: From Paper to Practice, from Centre to Citizen

Very few would dispute the goals of this plan. Neighbourhood Health Centres, healthier populations, more and better technology: these are all admirable intentions. But the truth is that successive governments have promised to deliver this vision and successive governments have failed.

Yesterday we hoped to see more of the how rather than the what. Unfortunately, this is largely a plan without a plan. As NHS England chief executive Sir Jim Mackey himself admitted, the document is designed to create “energy and enthusiasm,” not to provide detailed guidance. What should have been the first step toward reform risks becoming a collection of good intentions.

We are not short of blueprints. What we lack is the courage to build. The courage to let go of control from the centre. And the humility to co-create the future with the people who know their places and spaces best.

The 10-Year Plan reflects much of the intent of Labour’s Health Mission. It shares its focus on neighbourhood care, prevention, digital transformation and patient empowerment. But it is not yet the full realisation of that vision. It lacks delivery detail, workforce investment, cross-government coordination and democratic accountability. Yet for all that, it provides something that has been missing in the last 14 years — long term thinking. Building on The Budget, the Comprehensive Spending Review and the Strategic Defence Review; long term thinking is back on the menu. Yet this won’t matter if the government can’t swing the electorate behind it before the next election.

The 10 Year Plan is, in short, a beginning. A necessary, hopeful beginning. But to move from mission to mandate, it must now be followed by:

• A workforce strategy focused on future capability and capacity.

• A prevention plan that goes beyond clinical risk to tackle structural drivers of health and health inequalities.

• A delivery infrastructure for relational, place-based care that aligns strategy and resources across organisational silos.

• A digital transformation agenda grounded in capability, trust and a human-centred future.

• A civic contract that embeds power in places and the people within them, not just programmes.

Public services will not be renewed by tweaking institutions. They will be renewed by reimagining relationships — between people, professionals and systems. The NHS 10-Year Plan offers a glimpse of that future. It is now up to government, and all of us, to make it real.

Let’s make the neighbourhood not just the place of reform, but the soul of it.