Listen. Draw. Change.
Neighbourhood Health
The Systemic Landscape
43 NNHIP sites. 250 neighbourhood health centres planned. Five layers from national policy to neighbourhood delivery, and the gaps between them.
5 layers · 16 institutions · 5 funding streams · 43 NNHIP sites · 3 evidence services. Click any node for detail.
Explore the core elements →What is Neighbourhood Health?
Neighbourhood health is the centrepiece of the NHS 10 Year Health Plan for England (published June 2025). The goal: shift care from hospitals to communities, move from sickness to prevention, and bring services including diagnostics, mental health, outpatients, rehab, and social care, closer to where people live.
The programme
The National Neighbourhood Health Implementation Programme (NNHIP), chaired by Sir John Oldham, backs 43 Wave 1 sites with £10M nationally. Sites are expected to build Integrated Neighbourhood Teams, bringing together GPs, community nurses, hospital specialists, social workers, pharmacists, and voluntary sector organisations under one coordination structure.
The challenge
Sites have coaching and learning support but minimal additional funding for delivery. The Medium Term Planning Framework (April 2026 – March 2029) sets targets including 90% same-day GP access for urgent cases, 25% outpatient diversion across 10+ specialties, and 95% care plan coverage for complex needs. All to be evidenced at site level.
Scope
The Neighbourhood Health Framework and NNHIP apply to England. Scotland, Wales, and Northern Ireland each have devolved health systems with parallel community care programmes. The systemic tensions mapped in this resource, including fragmented stakeholders, evidence gaps, and funding pressure, are common across all four nations.
Key delivery targets (by March 2029)
90% of clinically urgent patients seen same day by March 2027
25% outpatient diversion rate across 10+ specialties by March 2027
95% of people with complex needs have a care plan
80% community health services activity within 18 weeks
Core Elements
Every neighbourhood health system has the same five layers. Most people only see one or two. When you see all five, and how they connect, you can act.
Purpose.Why does this place exist?
The clinical mission. What you're trying to change.
Reduce A&E pressure
Folkestone proved 85% reduction is possible. Stockton and East Birmingham are delivering 7-10% in year one.
Close health inequalities
NENC: highest under-75 preventable mortality in England. Thanet: 21% population in bottom 10% deprivation.
Shift hospital → community
The 10 Year Health Plan's core directive. 43 NNHIP sites are the testbed. What works here scales nationally.
Place.Where are the people?
Geography shapes everything. Deprivation, access, distance, isolation.
Coastal deprivation
Thanet, Portsmouth, Sunderland. Isolated communities where GP access is lowest and emergency demand highest.
Urban density
East Birmingham, Barking & Dagenham, Lambeth. Diverse, high-need populations where every GP surgery serves a different community.
Neighbourhood boundaries
Where does your neighbourhood start and end? Who drew the line? Does it match how people actually live? Most sites haven't answered this.
Habitat.What's built?
The physical infrastructure where care actually happens.
Neighbourhood health centres
40-50 new centres funded via £426M. Washwood Heath is the model: co-located UTC + CDC + community services under one roof.
Estates backlog £11.6Bn
Buildings failing. Equipment ageing. Every capital bid needs evidence architecture: who's affected, what breaks, what happens next.
Primary care networks
The delivery unit for neighbourhood health. Barking has 6 PCNs under one CIC. Most sites have fragmented networks with no shared governance.
Environment.What's the system?
Policy, funding, regulation. The water your site swims in.
NNHIP programme
£10M across 43 sites (~£230K each). Coaching only, no implementation budget. 12-month evaluation approaching. Sites that can't show evidence lose momentum.
ICB transformation funding
£6Bn for community shift. Better Care Fund pooled NHS/LA budget (+4.4%). S106 developer contributions. Multiple pots, and nobody has mapped how they connect.
Structural upheaval
NHSE absorbed into DHSC by April 2027. 42 ICBs merging to ~25. 50% running cost cuts. Who decides what, and when, is unclear.
Organisation.Who governs?
The people and institutions. Who's at the table. Who's missing.
ICBs (the commissioners)
They hold the budget. They decide what gets funded. NENC, BSol, NCL, Kent & Medway, each with different priorities, deficits, and merger pressures.
The neighbourhood team
18 roles per site: community nurses, GPs, hospital doctors, social workers, pharmacists, VCSE, council. They need to coordinate but nobody owns the whole picture.
Who's missing
The patient voice. The community perspective. The evidence that proves integration is happening, not just that meetings are happening.
The gap
Most sites see their own layer clearly but can't see how the layers interact. The GP knows the patients. The council knows the deprivation data. The ICB knows the budget. Nobody has the picture that shows all five at once.
The sites that succeed at 12 months will be the ones that drew this picture early.
Six Systemic Tensions
The forces pulling NNHIP sites in different directions. Every site navigates some combination of these.
ICB deficit.75% in deficit, £2.2Bn overspend
Sites need evidence of value for money.
ICB mergers.42 to ~25
50% running cost cuts. Merger creates stakeholder coordination need.
NHSE absorbed into DHSC by Apr 2027
Decision-making authority unclear during transition.
NNHIP: coaching only, no delivery budget
43 sites told to transform with minimal resource. The gap between ambition and implementation is where most sites stall.
Estates backlog.£11.6Bn
Buildings failing. Capital bids require structured evidence of need, impact, and community benefit.
Digital gap.£5Bn + £2.25Bn
Paper-based, siloed data. ITUEDA fills this for ICU quality.
What happens if you reach out
Not a sales process. Not a discovery phase. Three steps, and you're in control of every one.
I map who matters and what's missing.
You give me 20 to 30 minutes of your perspective. I give you back a picture of your stakeholders, your evidence, your gaps: something you can show your board. If it matches what you're seeing, we talk about step 2. If it doesn't, you tell me where I'm wrong. Either way, the map is yours to keep.
A few days. One conversation. No cost, no commitment.
We map your stakeholders.
If the picture was useful, the next step is a proper stakeholder sprint. Around 10 days. I map everyone who matters to your neighbourhood.NHS, social care, council, VCSE, primary care.and how they connect. You get a complete stakeholder map and engagement strategy you can act on immediately.
~10 days. One deliverable your Place Director can present to the ICB board.
We build the evidence NHSE will ask for.
The stakeholder map shows you who's involved. The evidence hub shows you what's working. Dashboard, baseline metrics, reporting rhythm.the thing NHSE will ask for at 12 months, built now so you're not scrambling later. This is what makes the difference between a site that proves impact and a site that has meetings.
~30 days. The foundation that makes your site audit-ready.
Each step is a decision point. You can stop after any one. Step 1 costs nothing. Step 2 and 3 are scoped and priced after the conversation.never before.
Who you're talking to
I'm Santosh. I was at NHS Digital during COVID.I helped roll out the vaccine passport. Before that I was at Barclays, building the systems that kept the bank running when everything moved overnight. I've seen how the consulting industry works inside the NHS. I watched firms charge hundreds of thousands for decks nobody read. I watched agencies send juniors billed at senior rates.
I started RiDraw because I believe there's a better way. The person you talk to is the person who does the work. I'm not an agency. I don't send a team. I do it myself, and if it doesn't fit, I'll tell you.that's free.
Start with step 1.
Tell me what's happening at your site. I'll draw the picture. If it's useful, we'll talk about what comes next. If it isn't, you've lost nothing but 20 to 30 minutes.
santosh@ridraw.com · or WhatsApp 07428 435 688