Developed in partnership between London’s five integrated care boards, NHS England London Region, and the wider London Health and Care Partnership (London Councils, Greater London Authority, UK Health Security Agency, and the Office for Health Improvement and Disparities in London), with support from Londonwide Local Medical Committees.

The neighbourhood health service in London builds on two simple ideas – we need to do things better, and we need to do better things.

Health and care is increasingly being overwhelmed by demand, public satisfaction is dropping, and health inequalities growing – even though as a country we are spending more on healthcare than ever before.

In jointly producing these documents:

• The Case for Change in London
• The Target Operating Model for London
• The Proposed Next Steps to Support Implementation

We have heard from clinicians, professionals, patients, carers, community leaders and elected representatives about the many opportunities to improve how we work together.

Through recent deliberative engagement across the capital, Londoners have reinforced their desire for more accessible and consistent care, using new technologies where appropriate, whilst remaining sensitive to individual and community needs. This is in turn supported by a national direction focused on increasing investment in prevention, community-based care, and harnessing the power of digital.

Balancing these ambitions is not easy, but our proposed model and the actions we believe will deliver it, incorporate existing learning, best practice and proposals from across North West, North Central, North East, South East and South West London. All focus on improving population health, improving the sustainability of health and care services, and addressing health inequalities across age groups.

One challenge in describing the neighbourhood health service is that it is about delivering coordinated health and care in a way that many people assume it is already delivered today – until they or a loved one experience a significant healthcare need. The Target Operating Model for London sets out ten core areas (supported by an eleventh, around managing the transition), where we are jointly committing to enabling a neighbourhood health service for every neighbourhood in London. This means in every place in London, we work together across:

• primary, community, mental health, and specialist services;
• children and young people’s and adults’ social services;
• public health, housing, and wider public services;
• voluntary, community, and faith groups;
• and with patients, carers, families, and communities themselves – all to improve individual and community health and wellbeing.

We believe we will get further and faster, by developing this new way of working together than we will alone. And yet, unleashing the existing potential within our teams, communities and technology will not be enough on its own.

Through this process, London is committing to moving our collective focus into addressing the causes of ill-health and poor wellbeing, and not just becoming better at responding to symptoms. We have talked about this for a long time. To achieve it now will require radical changes in how we plan, develop, deliver, fund and evaluate the impact of our services and relationships across London.

We recognise that in committing to these aims, we do not yet have all the answers. How we express ourselves can be as important as what we say. In the accompanying documents, we speak of the need for an existing organisation in each borough, determined by the partners in that borough, to host the necessary functions to enable neighbourhood working at scale. The term “Integrator” is the best we have come up with, so far. What is critical in this context is that we will not achieve the required scale of change without significantly expanding the support to those working on the frontline and ensuring the sustainability of every part of our health and care system, including but not limited to our hospitals, our GP practices and community pharmacies, social services and the voluntary and community sector in London.

To be successful we know we will need to do this not just in the coming year, but in successive years – and not just in London, but nationally, working with professionals and communities to make difficult decisions around how to prioritise limited resources and how to ensure the best chance of success.

The documents we can share today are, at best, ones which set out key questions we need to answer. They will change and evolve as we develop our responses.

However, only by working in partnership will we be able to face the broader challenges affecting all parts of London and the country as a whole: to create something in London that is genuinely better and more sustainable in meeting the needs and aspirations of the communities we serve.

Signatories

Andrew Bland,
Chief Executive Officer, NHS South East London Integrated Care Board and Primary Care Transformation Lead for London, Co-Senior Responsible Officer

Will Huxter,
Director of Commissioning, NHS England (London Region), Co-Senior Responsible Officer

Dr Agatha Nortley-Meshe,
Regional Medical Director for Primary Care, NHS England (London Region), Co-Senior Responsible Officer

Caroline Clarke,
Regional Director, NHS England (London Region), Co-Chair of London’s Health and Care Partnership

Katie Fisher,
Chief Executive Officer, NHS South West London Integrated Care Board

Frances O’Callaghan,
Chief Executive Officer, NHS North Central London Integrated Care Board

Rob Hurd,
Chief Executive Officer, NHS North West London Integrated Care Board

Zina Etheridge,
Chief Executive Officer, NHS North East London Integrated Care Board

Ali Griffin,
Chief Executive Officer, London Councils

Tunde Olayinka,
Executive Director, Communities and Skills, Greater London Authority (GLA)

Dr Lisa Harrod-Rothwell,
Chief Executive Officer, Londonwide Local Medical Committees (LMCs)

Professor Kevin Fenton,
Regional Director,
Office for Health Improvement and Disparities (London)

Regional Director of Public Health, NHS England (London Region)

Statutory Health Advisor to the Mayor of London, GLA and London Assembly

Andrew Blake Herbert,
Chief Executive Officer of London Borough of Havering,
Co-Chair of London’s Health and Care Partnership