Will the shift to neighbourhood health narrow the gap?

Health inequalities remain one of the most persistent challenges in our system, and turning ambition into real change is often far from straightforward. This blog series looks at the 10 Year Health Plan for England through an inequalities lens – exploring where the evidence shows we can make the biggest difference, and the potential pitfalls we should avoid. Across the series, our Associate Director for Policy and Practice Engagement, Dr Liam Loftus, draws on the evidence base to highlight what is most likely to work in practice.

It is hard to ignore the government’s intention to shift care from hospitals into communities. At the centre of the 10 Year Health Plan for England (subsequently, the “Plan”) is a renewed commitment to a Neighbourhood Health Service – one that offers care “on your doorstep and from the comfort of your own home,” supported by Neighbourhood Health Centres in every community.

For areas with the lowest healthy life expectancy, this shift could be transformative. But it will only improve equity if it is designed and delivered with inequalities front and centre. This blog explores three of the pillars of the neighbourhood agenda – co-location, Integrated Neighbourhood Teams, and community health workers – and what the evidence tells us about their potential to narrow the gap.

A defining feature of Neighbourhood Health Centres is the ambition to bring a wide range of services together – physical and mental healthcare, welfare advice, employment support, smoking cessation and weight management – all under one roof. Encouragingly, the Plan commits to opening the first centres in areas with the lowest healthy life expectancy.

But does co-location work to reduce inequalities?

To understand this, we at the Health Equity Evidence Centre conducted an umbrella review of the existing evidence. We found the strongest benefits in mental health, where co-located models can improve access and reduce waiting times. For welfare and legal advice, co-location increases the identification of people who need support and reduces the amount of personal agency required to access services – important given that navigating complex systems is harder for those facing disadvantage.

However, the evidence base is inconsistent and often low-quality. And crucially, co-location alone does not guarantee integrated care. Simply putting services side-by-side rarely leads to meaningful collaboration unless the conditions are right: a shared vision, co-production with local communities, and strong communication across teams.

In short, co-location can support more equitable access, but it is more of a facilitator, rather than a substitute, for genuine integration.

The Plan situates Integrated Neighbourhood Teams (INTs) as the operational backbone of the Neighbourhood Health Service. These teams are expected to convene professionals from primary, community and acute care, social care, and potentially wider partners such as hospices and the voluntary sector.

But bringing teams together will not automatically reduce inequalities. Our review of the evidence (free-to-read in our Evidence Brief) highlighted four key principles that should inform the design and implementation of INTs. 

While evidence is still emerging, these principles offer a clear steer on how to form INTs in ways that actively reduce inequalities rather than unintentionally widen them.

For me, Community Health Workers (CHWs) are one of the most exciting elements of the neighbourhood vision. Building on a model that originated in Brazil, CHWs are trained, paid local residents who carry out proactive, proportionate outreach – typically supporting around 150 households with monthly visits, regardless of need or demand. This creates a personalised, relational form of prevention that goes beyond traditional health promotion campaigns.

There is now a growing evidence base supporting this model. A recent evaluation of a Westminster-based CHW programme demonstrated striking results in just ten months:

These outcomes show the potential for CHWs to bridge gaps in trust, engagement and access – issues that disproportionately affect disadvantaged communities. Scaling this nationally, however, will require serious investment. A full rollout is estimated at around £2.2 billion in salary costs. A more targeted implementation – focused on Primary Care Networks in the most deprived 20% – would cost closer to £300 million. Whether the government’s warm words translate into funding remains an open question.

A real opportunity, if inequalities are kept front-and-centre 

The shift to neighbourhood-based care could be one of the most significant reforms in a generation. If implemented with equity at its core – through meaningful co-location in areas of highest disadvantage, empowered and well-designed Integrated Neighbourhood Teams, and investment in community health workers – the ingredients are there for real progress.

But ambition alone is not enough. Tight public finances, workforce pressures and political incentives to prioritise short-term challenges all pose risks to delivery.

Leaders across the NHS will need to hold the government to its promises and ensure that the shift to neighbourhood care is delivered in a way that benefits the communities who stand to gain the most. Done well, this approach could lay strong, evidence-based foundations for a more equitable health system. Done poorly, it risks becoming yet another missed opportunity.