In response to the Department of Health and Social Care’s new Neighbourhood Health Framework, Public Policy Projects convened senior regional and national leaders in Manchester to explore how neighbourhood health is being delivered in practice. Hosted by our health and care team as part of PPP’s 2026 Neighbourhood Health Programme, the roundtable brought together voices from across in health, care, local government, housing, technology, academia and the VCFSE sector to test national ambition against place‑based experience in Greater Manchester where neighbourhood health is already being delivered.
What came through clearly is that systems are being asked to perform a delicate balancing act. Neighbourhood working is expected to do two things at once: improve long‑term population health and relieve immediate pressure on hospitals. These objectives are not always aligned. Prevention improves lives, but it does not automatically release acute capacity or savings at the pace national targets demand. Overselling neighbourhood health as a quick fix risks disappointment.
If delivery is faltering, it is not for lack of local capability. Participants were blunt: the biggest blockers are structural, not cultural. Decision‑making power remains tightly held. Budgets flow vertically through organisations rather than horizontally across places. Accountability is fragmented, and incentives frequently pull partners in opposite directions. In short, systems are trying to integrate at neighbourhood level while money and authority remain centralised.
Funding flows matter as much as funding levels. Funding challenges remain a significant obstacle to scaling neighbourhood health. Rigid, nationally determined allocations continue to reinforce silos between acute, community, social care and voluntary sectors, slowing the much‑talked‑about “left shift”. Where neighbourhood models are working -- places like Rochdale and Leeds were referenced - they are doing so because local partners have been given room to align resources around shared outcomes.
Neighbourhood health is not an NHS‑only endeavour. Housing, local government, social care and the voluntary, community and faith sector (VCFSE) are not peripheral players; they are central to success. Health outcomes are shaped far more by homes, work and communities than by clinical care alone. Yet many of these partners remain underfunded and under‑powered, despite being essential to prevention and community engagement.
What does this mean in practice? Governance, partnership and contracting are no longer abstract concerns. They are live operational issues. Systems need advice on joint commissioning, integrator functions, risk‑sharing and accountability frameworks that reflect how care is actually delivered on the ground. Health and Wellbeing Boards have a pivotal convening role, but without stronger levers they cannot carry the weight alone.
The Manchester discussion was the first in a series of PPP neighbourhood health roundtables, and it set the tone. Neighbourhood health will scale only if the system changes with it — devolving decision‑making, aligning incentives and measuring success by outcomes that matter to people, not just organisational performance.
You can read the full Public Policy Projects write up of the Manchester roundtable for a deeper dive into the discussion and evidence here.
These issues will be explored further at the next PPP neighbourhood health roundtable in Birmingham on 30 April, which will focus on moving from framework to delivery and the mechanisms that enable collaboration between health and social care.
To discuss any of the issues raised here, please contact Rob Day or Charlotte Lewis. Our neighbourhood health multidisciplinary team offers support on governance, partnerships, contracting, and complex commissioning decisions.
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