Neighbourhood Health and Healthy Neighbourhoods are two very different things: An interview with Roy Lilley

Roy Lilley knows a lot about healthcare provision in the UK, and he shares it four times a week with relevance, facts and humour through a widely distributed newsletter. His knowledge and insight come from experience leading two health authorities, running the NHS Managers network and supporting the Institute of Health and Social Care Management.

He's also been an active participant in local government, having served as Councillor and Mayor in Surrey Heath Borough. And he works closely with research and charitable organisations, including the Kings Fund, the Community Hospitals Association, and his own invention, the Academy of Fabulous Stuff, a “repository of inspirational ideas” for the NHS.

I’ve known Roy for some time, and admire his energy and commitment to improving the NHS through collaborative thinking and approaches. He talks the talk and, crucially, walks the walk -- and nothing demonstrates this better than yet another of his collaborators, Altogether Better, which supports organisations and local people to find new ways of working together to deliver neighbourhood health services.

There’s lots of reports and commentary on neighbourhood health since the government published its Neighbourhood Health Framework earlier this year. Not surprisingly there is a large gap between intentions and practice, and I, perhaps like many, struggle to fully understand how, where and why it’s working well. So I went and asked Roy.

Here's my interview.

1.   How would you describe Neighbourhood Health?

It is an attempt to organise care around people and places rather than hospitals and institutions.

At its best, it brings together general practice, community services, mental health, social care, pharmacy and voluntary organisations around a defined local population.

The important point is that it is a way of working, not simply a new building with a sign over the door.  We have to get into our heads, this is not neighbourhood health… it’s the health of the neighbourhood and go from there.

2.   Is it integral to the shifts from hospital to community, analogue to digital and sickness to prevention?

Yes. It is probably the main way those three ambitions will be delivered.

Digital systems should help local teams share information. Better neighbourhood services should allow more care to move out of hospital. Knowing the local population should make earlier intervention and prevention more realistic.

The danger is that the three shifts remain slogans rather than changes in where the money, workforce and accountability sit.

3.   Will delivery require reinvestment, and how should outcomes be measured?

Yes. You cannot reduce hospital capacity before community services are ready to take on the work.  And, even then you have to think about double running costs.

There will have to be a period of double-running, alongside investment in staff, premises, technology and data.

Success should be measured through fewer avoidable admissions, shorter hospital stays, better control of long-term conditions, improved independence and a better patient experience.  There is some evidence that the CDCs are standing idle for the wan’t of staff.

We should measure what changed for patients, not the number of meetings held or partnerships created.

4.   What are the financial implications locally?

There are two costs: capital and revenue.

Capital is needed for buildings, diagnostics and digital infrastructure. Revenue is needed for the people who actually provide the care.

The risk is that we create attractive neighbourhood centres without enough recurring funding to staff them properly.  The real test is whether money and activity genuinely move from avoidable hospital care into stronger local services.

5.   Is this a shift of resources from the NHS to charities, faith groups and others?

It should be a partnership, not an offloading of NHS responsibility.

Community, charitable and faith organisations often understand local people better and may be more trusted than statutory services.

However, they should not become the cheap end of the supply chain. If they are expected to provide essential services, they need proper contracts, reliable funding and clear accountability.  Often they are small and have weak balance sheets which are not robust enough for NHS contracting.

6.   Does social prescribing have an important role?

Yes, but it should not be oversold.

Many people visiting a GP need help with loneliness, debt, housing, exercise, employment or social connection rather than another medical intervention.

Social prescribing can connect people with that support. However, it is not a substitute for properly funded mental health care, housing, social care or welfare services.

There is little point issuing a social prescription to a community organisation that has no secure funding.

7.   What is your view of the social determinants of health?

They are fundamental.

The NHS often deals with the consequences of poor housing, low income, insecure work, bad transport, pollution, loneliness and weak educational opportunity.

A doctor can treat a child’s asthma but cannot prescribe away damp housing.  We are the dustcart that follows the Lord Mayor’s Show of life.

Healthcare matters enormously, but it is only one part of health. We should also be careful not to turn every social problem into a medical one.

8.   How should investment in these determinants be managed?

The best principle is national guarantees, local decisions and transparent outcomes.

National government must address issues such as income, housing standards, welfare and employment rights.

Local organisations are better placed to decide which problems matter most in their neighbourhoods and how to tackle them.

The taxpayer should be able to see how the whole local public pound is being used, rather than NHS, council and housing budgets operating in separate silos.

9.   Is there a one-size-fits-all framework?

There can be a common framework, but not a standard answer.

Every area should examine who is becoming ill, where they live, what is driving the problem and whether services match local need.

But the response in an inner-city estate will be different from the response in a coastal town or rural community.

The right model is national standards and data, combined with local freedom to act.  Stopping people getting sick in the first place is the only way the NHS can survive its capacity and funding problems.

10.   Are Blue Zones a valid concept for Neighbourhood Health?

They are useful as inspiration, but not as a blueprint.

Their strongest message is that health is shaped by everyday life: movement, diet, social connection, purpose and the design of the environment.

We should be cautious about some of the more extravagant longevity claims and the idea that a branded programme can simply be imported.

The useful lesson is to create places where healthy choices are easier and social connection is part of daily life.

11.   How should councils, health services and developers align around regeneration?

Health must be involved at the beginning, not consulted after the plans have been drawn.

Councils bring planning powers, public health and housing. The NHS brings clinical knowledge and service planning. Developers bring land, capital and delivery capacity.

They should work to one neighbourhood health plan covering housing, transport, air quality, green space, employment, social infrastructure and access to care.

The objective is not simply to build another GP surgery. It is to build a healthier place.

12.   How can NHS and geospatial data be used at neighbourhood level?

Much of the data already exists, but it sits in different organisations and rarely joins up.  We must mutualise data and resolve some of the GDPR blockages between health and social care.

NHS data should be linked securely with information about housing, deprivation, transport, pollution, employment, education and population change.

That would help identify, for example, where respiratory admissions coincide with poor housing or where falls are rising but rehabilitation services are limited.

The danger is creating another impressive dashboard. Data is only useful when somebody has the authority, money and responsibility to act on it.

My sincere thanks to Roy for his time, insight and candour.

Clare Delmar

Listen to Locals

22 July 2026