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Service reform must start with an understanding of 'neighbourhood'

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NHS England chief executive Simon Stevens recently suggested that the ‘N’ in ‘NHS’ needs to stand for ‘neighbourhood’ as well as ‘national’.

As I’ve argued here before, despite the idea of individual tailoring of services inherent in personalisation, we have not tended to organise services on a small scale.

Where once we saw the industrial scale as the most logical, now we see operating at a large scale as a necessary evil inherent in the large numbers of people requiring support in a given area. So what is the best scale at which to organise our public services?

Mr Stevens is clearly interested in playing with the idea of scale: NHS England is promoting personal health budgets which are already enabling people to create and manage their own packages of care at an entirely individual level.

But he is also the architect of Devo-Manc, the devolution of health and care organisation to one of the largest conurbation areas in England. Both of these ideas play with the idea of scale, but neither is based on working at the neighbourhood level, so what was Mr Stevens referring to?

The Think Local, Act Personal partnership held an event with Mr Stevens and other health care leaders recently, in which they committed to producing a shared understanding of what it means to build community capacity or social capital.

TLAP has produced a guide on this subject for health and wellbeing boards. Public Health England has developed a conceptual framework and NHS Confederation has working with communities at the core of its strategy.

All these bodies agree that it is not enough simply to move services to ‘the community’; it is also vital to know how to engage with communities, building connections between people and unleashing the capacity that is often already within our neighbourhoods, but poorly recognised and valued.

We can see this in the rapid growth of local area co-ordination, an approach in which area co-ordinators are embedded at the neighbourhood level, getting to know isolated or vulnerable people and helping them to reconnect with those around them.

The TLAP guide suggests that building community capacity starts with understanding not just the needs of an area, but its assets. This starts with understanding a place from its residents’ point of view: in other words, understanding what they regard as their neighbourhood, invariably smaller and distinct from administrative boundaries.

The challenge for Greater Manchester may well be to scale down to the level of the neighbourhood.

Alex Fox, chief executive, Shared Lives, and board co-chair, Think Local Act Personal






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