The NHS’s 10-Year Plan paints a compelling vision: health services rooted in neighbourhoods, driven by prevention, and delivered in partnership. It’s a shift from crisis response to proactive, person-centred care.
But vision without collaborative execution risks becoming another “grand strategy” that dies in the committee room. The real work—the knotty, political, relationship-driven work—happens in how partners collaborate on the ground.
This is where the Population Health Canvas—originally developed by the Wicked Problems Hub—offers not just a framework, but a discipline.
Identifying Need – Start with Shared Reality, Not Assumptions
The people who come together to form neighbourhood teams often discover they’re using different data, definitions, and thresholds for “need”. One GP practice might prioritise frailty; the local authority may well be focus on homelessness, and local community organisations are voicing concerns about the wider determinants of health and their impact on people's mental wellbeing.
Collaboration challenge: Building a single, shared view of the local population means blending NHS data, local government intelligence, and voluntary sector insights—and agreeing what’s in and out of scope. Without this, integration becomes parallel play.
Addressing Inequalities – Beyond Tokenism
The 10 year plan talks a lot about tackling health inequalities, but tangible actions often gets stuck at generic commitments from system leaders. Who's never heard the pledge “we will reduce health inequalities”?
Collaboration challenge: Partners really need to agree which inequalities matter most locally, and how to measure progress. All too often a lack of agreement on which inequalities matter the most means that there is a lack of focus, with different partners focussing on what they believe is a priority. Worse - too broad a focus means that lots of talking happens, but little in the way of action. I often recall the phrase "don't try to eat the elephant whole"
The voluntary and community sector (VCSE) often has the richest qualitative insight into marginalised groups—but they are rarely funded to contribute at scale. VCSE organisations need to be respected and treated as equal partners - they will often know more about the realities of what it is like to exist in their local neighbourhoods than even the most engaged commissioner or service manager.
Clear Prioritisation – Choosing What Not to Do
Every neighbourhood could list fifty pressing needs. The harder—and more important—task is agreeing on the top three to five priorities for the next 12–18 months. As with health inequalities don't try to eat the elephant whole!
Collaboration challenge: This means some partners will have to park their own organisational priorities in favour of shared goals. That takes political courage, transparent criteria, and trusted facilitation.
Defined Outcomes – Moving from Activity to Impact
If success is defined only by outputs (“200 more people seen”), you miss whether health actually improves. Government and the NHS are historically very good at creating performance metrics, KPIs, accountability frameworks that focus on activity, rather than outcomes and impact. Whilst they can be helpful in understanding what systems are doing, they are less helpful in understanding what difference a system has made. This is problematic when planning large scale change - the system ends up being designed around achieving the perfomance metrics, and not about making a real difference to the communities served.
Collaboration challenge: Agreeing shared outcome measures is tricky when sectors use different metrics and accountability lines. But it’s the only way to ensure joint work actually shifts the dial.
Collaboration with Partners – Power, Trust, and Turf
Integration demands equal partnership between NHS, local authorities, and VCSE. Yet decision-making often defaults to NHS dominance, sidelining community insight.
Collaboration challenge: This is less about organisational charts, more about relational infrastructure—the trust, respect, and conflict-resolution capacity to work through inevitable tensions. See our blog on absorptive capacity as a way of gaining collaborative advantage.
Incentives – Aligning the System’s DNA
If budgets, KPIs, and career incentives reward siloed success, collaboration is doomed. However, it's not all about budgets and money. The incentives need to be aligned so that there is mutual non-financial benefit across partners too!
Collaboration challenge: Neighbourhood health will thrive only if financial flows, performance frameworks, and political recognition actively reward joint outcomes—not just organisational performance.
How the Wicked Problems Hub Can Help
The Wicked Problems Hub specialises in facilitating multi-sector collaboration on exactly these complex, cross-boundary issues. Applied to neighbourhood health, it can:
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Map system dynamics to uncover hidden dependencies and conflicts.
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Facilitate prioritisation that is politically and operationally sustainable.
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Embed shared measurement that bridges NHS, local government, and VCSE perspectives.
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Design incentive structures that reward collaborative behaviour.
Final Word
Neighbourhood health services could be the NHS’s most significant reform in a generation. But their success won’t be determined by architecture, buildings, or even funding alone—it will be decided by whether partners can agree on needs, address inequalities, choose priorities, define outcomes, share power, and align incentives
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