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Locality calls for more community power in the NHS 10 Year Plan

As the consultation closes on the NHS 10 Year Health Plan for England, Locality and partners are calling for a neighbourhood health service with community power at its heart.

Locality has joined forces with national community sector partners Local Trust, New Local, and Power to Change to send a joint response to the public consultation on the NHS 10 Year Health Plan for England.

This week the government closed its consultation on the future of the NHS. Its 10 year plan has a big, bold goal: to shift to a model that’s less about tackling sickness in hospitals, and more about keeping people well in their communities. The good news is, it doesn’t need to reinvent the wheel: as they key national community sector organisations, we know this vision of a “neighbourhood health service” is already with us.

Community organisations have always been critical to tackling health inequalities and keeping people out of hospital. “Prevention” has rightly become health policy’s primary goal, and it’s the local people who are close to the ground that are often best placed to do it.

St George’s Lupset, who work in one of Wakefield’s most disadvantaged neighbourhoods, call it creating “health and wealth by stealth”. People are supported to make the changes they need without even realising it. They are afforded the space and time to connect with one another, build relationships and access trusted advice.

Wider health systems – from GPs to council public health teams to Integrated Care Boards (ICBs) - are starting to value this hyper-local activity. West Yorkshire has become the first “Keep it Local” ICB. Cornwall’s NHS is now working through a network of community hubs.

So the 10 Year Plan presents an opportunity: to build on this bedrock of community power, and invest in the organisations and institutions that keep people healthy. To do this, we’re calling for a 5% shift in health budgets towards community-led prevention work, but also for a wider refocus of our health service towards one that starts at a neighbourhood level. You can read our full recommendations below.

The community-powered health revolution is already happening. We need the 10 Year Plan to put the full weight of government behind it.

Tony Armstrong, CEO, Locality

Tim Davies-Pugh, CEO, Power to Change

Matt Leach, CEO, Local Trust

Jessica Studdert, CEO, New Local

What we're calling for

Based on a comprehensive body of research produced in recent years, we have laid out how the government’s three proposed shifts for the NHS – hospital to community, analogue to digital, and sickness to prevention – will only succeed if they embrace the power of community. We know just how vital community organisations, community businesses, and the wider local VCSE sector are to keeping people well in the places they live.

They provide holistic, person-centred support across all of the wider determinants of people’s health, like housing, employment, and social networks. They create inclusive and culturally competent services for communities experiencing the most acute health inequalities. And they provide a familiar, trusted face to help people access the health services they need in their local area.

As such, they will be crucial to the government’s new vision of the NHS as a “neighbourhood health service” that focuses on keeping people healthy in their communities and providing services closer to home.

To achieve this, we’re calling on the government to commit to 10 policy changes across the short, medium, and long-term. In order of priority, they are to:

1) Ensure all local VCSE organisations receive funding for the activities they are asked to provide for social prescribing referrals (short-term).

2) Require a 5% shift in health budgets towards community-led, primary prevention and health creation based on the wider determinants of health across services at the neighbourhood level (medium / long-term).

3) Renew and expand the Community Ownership Fund to create a 10-year, £1bn programme, ensuring that the trusted community spaces integral to a neighbourhood health service are safeguarded for the future (short-term).

4) Expand the Additional Roles Reimbursement Scheme to support an increased investment in Social Prescribing Link Workers, Health and Wellbeing Coaches, and other roles focused on wider-determinants-led prevention and health creation, to be employed directly by local VCSE organisations and embedded in integrated neighbourhood teams (short / medium-term).

5) Provide core funding for local VCSE organisations to support and build their trusted, holistic, person-centred support as part of hospital discharge pathways, community support for frequent A&E attendees, and general illness prevention and health creation services. This should prioritise the 225 areas of double disadvantage as identified by Local Trust and build on the dormant-assets-supported Community Wealth Fund to deliver long-term, resident-led funding in these areas to develop health and wellbeing promoting activities, services and, facilities (short / medium-term).

6) Produce national guidance for Integrated Care Systems encouraging adoption of the Keep it Local approach, following in the footsteps of West Yorkshire Health and Care Partnership. This should emphasise its facilitation of the increased opportunities for commissioning local VCSE organisations to deliver healthcare services under the Provider Selection Regime (short-term).

7) Produce national good practice guidance on data governance frameworks and data sharing agreements for health system partners at neighbourhood and place level. This should support local VCSE organisations to read and write into single patient records at an appropriate level and evidence impact in a standardised format. This can help facilitate, among other things, Additional Roles Reimbursement Scheme funding for preventative roles in the VCSE sector (short / medium term).

8) Commission national research and guidance on the best practice for co-locating statutory health services within community-led spaces and VCSE services within the NHS estate (short-term).

9) Use this research to support the development of truly community-based and led neighbourhood health centres. This includes on the high-street, where the provision of health services can help spark social and economic regeneration as per the “fourth purpose” of ICSs to support broader social and economic development (medium / long-term).

10) Commission a national review into the process for determining the geographic footprint of Primary Care Networks, with the aim to more closely align them with community understanding of neighbourhood footprints and, in doing so, improve the functioning of integrated neighbourhood teams (medium / long term).

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