The neighbourhood health service is built around a straightforward idea. Families should be able to access more care closer to home, through services that work together more effectively around their needs. That matters for children’s health, where support often spans health visiting, early years, primary care and wider family services. As policy continues to shift from hospital to community, analogue to digital and sickness to prevention, it is worth looking more closely at what that means for families in practice, and how services such as Best Start Family Hubs and the healthy child programme fit into that picture.

From hospital to community: Rethinking care for children

For decades, the NHS has been anchored around acute hospitals. Families often travel long distances for consultations that could happen closer to home, while early interventions are missed until conditions become serious. The neighbourhood health framework envisions something different:

  • Integrated neighbourhood care: Services are organised around the places where families live. GPs, urgent care, diagnostics, community health teams, social care and voluntary services work together to meet needs in one place.
  • Focus on prevention: Strengthening primary and community services, moving outpatient appointments into neighbourhoods and improving access via phone, online or in person.
  • Reduced hospital pressure: By shifting care out of hospitals, the NHS frees acute resources for emergencies, reduces stress for families and cuts duplication.

This “left shift” recognises that the historical hospital‑by‑default model is unsustainable amid rising long‑term conditions and an ageing population. Organising care around neighbourhoods, typically about 50,000 residents, brings services into the lived realities of families and makes it easier to spot issues early.

A strategic framework for better health

The neighbourhood health service brings care closer to home and creates more connection between healthcare, early years support and the wider services families rely on day to day. Its goals include:

  • Improving population health and reducing inequalities;
  • Enhancing cost‑effectiveness by diverting demand from acute settings;
  • Improving user experience through coordinated care and a single front door;
  • Empowering citizens to manage their own health via digital tools and community support;
  • Prioritising high‑need cohorts through early intervention.

Delivery is phased through specific targets and milestones. The framework aims for 90 % of urgent GP patients to be seen the same day by March 2027, 25 % of outpatient activity shifted to neighbourhoods and a 10 % reduction in non‑elective admissions for high‑priority cohorts by 2029. By 2030 there should be 120 neighbourhood health centres, with 250 by 2035. Integrated Neighbourhood Teams (INTs) will cover all children by 2028/29, ensuring seamless transitions between universal and specialist services. These targets translate into tangible benefits for families: faster appointments, fewer school disruptions due to hospital visits and more stable support for children with complex needs.

New provider types and neighbourhood teams

To deliver this model the framework introduces three provider types:

  • A single portal for appointments, reminders and health records, reducing the need to remember multiple logins.
  • Proxy access so carers can manage dependants’ records and receive notifications when vaccinations or screenings are due.
  • Upfront checklists of required documents or vaccinations, helping families prepare for appointments.
  • Self service features that let families update contact details or raise concerns without waiting for an appointment.
Provider type Description Benefit for families
Single Neighbourhood Providers (SNPs) Deliver services within the core neighbourhood (≈ 50,000 people), working closely with local GP practices. Families see consistent teams who know their community and can provide personalised care.
Multi‑Neighbourhood Providers (MNPs) Coordinate care across larger populations (≈ 250,000), managing services that need scale (e.g. diagnostics, end‑of‑life care). Access to specialist services without needing to travel to hospital.
Integrated Health Organisations (IHOs) Hold the entire health budget for a defined population, incentivising investment in prevention. Encourages spending on early years services to reduce long‑term hospital admissions.

INTs bring together professionals from health, social care and voluntary sectors. In London, Croydon’s integrated neighbourhood teams provide proactive care planning, keeping residents out of hospital. Neighbourhood health centres are envisioned as inclusive hubs open at least 12 hours a day, offering community spaces such as cafés and gardens alongside multidisciplinary clinics. The 10‑year plan calls for a neighbourhood health centre in every community.

Best Start Family Hubs: The front door to local health

Central to the neighbourhood model for families are Best Start Family Hubs (BSFH). Reimagining the legacy of Sure Start, these hubs act as a physical and digital front door to services for children from pregnancy to age 19 (or 25 with SEND). The Education Hub describes them as one‑stop shops where parents can access classes, health support, parenting advice, SEND guidance and financial assistance. Key features include:

  • Multi‑agency collaboration: Health visitors, midwives, social care and voluntary sector support are co‑located, reducing the need for families to repeat their story and enabling a “team around the family” approach. This is crucial for families navigating the SEND system or facing financial stress.
  • Blended digital and in‑person support: The Best Start digital service within the NHS app offers trusted guidance and connects families to local hubs. Hubs provide face‑to‑face sessions such as stay‑and‑play, infant feeding support and perinatal mental health.
  • Holistic services: Hubs support early years development, health and wellbeing, SEND identification and navigation, and social and financial wellbeing. They offer debt advice, welfare guidance and housing support, recognising that health is shaped by social factors.

The healthy child programme

If BSFHs provide the infrastructure, the healthy child programme (HCP) provides the clinical framework. It is England’s universal public health nursing offer delivered by health visitors and school nurses, focusing on prevention and early intervention. Its principles include:

  • Proportionate universalism: All families receive universal services, but those with additional needs get targeted support.
  • Five mandated reviews in early years: Antenatal, new birth, 6–8 week, one‑year and two‑to‑two‑and‑a‑half‑year. The first three must be home visits, allowing assessment of family dynamics.
  • Continuity of carer: Families are assigned a named health visitor to build trust and ensure effective safeguarding.
  • High‑impact areas: The HCP focuses on maternal mental health, breastfeeding, healthy weight, speech and language, child development and safeguarding.
  • Transition to school nursing: As children grow, school nurses coordinate health and wellbeing, working alongside mental health practitioners and social workers.

Health visitors are positioned as system leaders under the 10‑year plan. They provide a clinical bridge between families and neighbourhood health services, ensuring early needs are identified, information is shared and support is coordinated.

Shifting services: What moves from hospital to community

The neighbourhood health service aims to “left shift” certain activities from hospitals into community hubs and homes. This isn’t simply about location but about redesigning pathways to be more responsive and less disruptive:

Care category Description of the shift Delivery mechanism
Planned chronic care Management of long‑term conditions such as asthma, diabetes and neurodevelopmental disorders. Specialist community clinics co‑located in neighbourhood health centres (NHCs).
Reactive urgent care Rapid response to sudden clinical needs and step‑down care after discharge. Urgent community response teams, virtual wards and integrated urgent care within NHCs.
Specialist diagnostics Tests such as phlebotomy or ultrasound that currently require hospital visits. Community Diagnostic Centres integrated into neighbourhood hubs.
Mental health Support for children and young people below specialist thresholds. Primary care talking therapies, youth clinics and mental health practitioners within INTs.

These shifts reduce hospital visits, minimise disruption to schooling and work, and allow children to receive care in familiar environments. NHCs serve as anchor institutions — vibrant hubs open long hours with child‑friendly spaces and multiple services under one roof.

Digital transformation: Building an interoperable backbone

A neighbourhood health service cannot succeed without fixing the analogue‑to‑digital gap. Currently, hospitals use at least 21 different electronic medical record systems, many of which cannot share information. On millions of occasions, clinicians treat patients without access to previous visit information, increasing the risk of errors. A digital transformation is needed:

Digital barrier Statistic/context Strategic solution
Fragmented systems 21 different commercial record systems across acute trusts. Unified national standards and converged electronic patient record (EPR) platforms.
Data access gaps 11 million hospital encounters occurred without access to previous visit information. Shared, interoperable records across health and social care.
Legacy infrastructure Some hospital log‑on times exceed 15 minutes due to outdated hardware. Sustained investment in basic digital infrastructure (PCs, Wi‑Fi, cloud).
Administrative burden Families must repeatedly “tell their story” to different agencies. A single patient record and NHS App integration enable professionals to access information and parents to manage care through one portal.

From November 2023 most patients can view new entries in their primary care records via the NHS App. The vision is for parents to manage their child’s appointments, receive reminders and access records directly through the app, supporting transparency and safety. However, this also raises workload and safeguarding concerns that must be addressed.

 

Challenges ahead: workforce, culture and accountability

The vision for neighbourhood health is ambitious and faces significant barriers:

  • Workforce deficits: Paediatric community nursing and health visitor numbers have declined, increasing caseloads and reducing capacity for preventative home visits. Long waiting lists for community paediatrics delay diagnoses and support for conditions such as neurodevelopmental disorders.
  • Cultural inertia: The NHS remains hospital centric. Shifting resources into the community means overcoming perceptions that hospital care is safer or that community care is simply cost cutting. Collaboration between the NHS, local authorities and the voluntary sector also depends on shared language and trust.
  • Metrics and accountability: Current performance measures prioritise acute targets such as A&E waits and elective backlogs, and do not capture the impact of prevention and early intervention for children. Without child specific metrics, neighbourhood health risks being overlooked.
  • Digital interoperability: Success depends on converging digital systems, ensuring data privacy and consent, and investing in training for both professionals and parents.

Addressing these barriers will require workforce expansion, sustained funding, cultural change and a clear shift in how success is measured.

What this kind of delivery depends on

Moving care closer to home depends on more than policy direction. It relies on services being designed in a way that allows different teams, systems and organisations to work together around the needs of families.

That includes the technical foundations, such as better interoperability and clearer data flows, but it also includes the day to day experience of using the service. Parents and carers need support to feel easier to access and easier to understand. Professionals need the right information to be visible without having to rely on manual workarounds.

Work such as the open source OMOP and synthetic data tooling developed around virtual wards shows the value of creating shared foundations that other services can build from. The context is different, but the principle carries across. Joined up care depends on joined up infrastructure, and the strongest delivery tends to come from approaches that can be reused, adapted and improved over time.

 

Towards a neighbourhood health service for every family

Transforming the NHS into a neighbourhood health service is about more than shifting appointments from hospitals to community centres; it is about building a system that recognises families’ lived realities. By integrating health, social care and education within neighbourhoods, investing in digital interoperability and empowering health visitors and parents, we can move from reactive, hospital‑centric care to proactive, community‑first care. For children, this means earlier interventions, better continuity and a holistic approach to health that addresses social determinants. For parents, it means accessible, coordinated support and a voice in their child’s care. Achieving this vision will require committed leadership, adequate resources and a willingness to redesign long‑held practices.

The prize is a healthier, more connected generation and a system that truly gives every child the best start in life.

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