Developing a Neighbourhood Health Theory of Change: Large scale system transformation for integration of care in England

Background: The NHS 10-year Health Plan for England (10YHP) establishes Neighbourhood Health (NbH), which emphasises moving care from hospitals into the community and better integrating teams and a variety of health, social care and Voluntary, Community and Social Enterprise (VCSE) organisations. However, it is currently unclear how this integration and NbH more generally is intended to work. In this presentation we will describe a theory of change (ToC) for NbH developed during the co-design of a national NbH evaluation.

 

Approach: A series of three co-design workshops were conducted in September and October 2025, with participants representative of a variety of stakeholders: Integrated Care Boards, NHS primary and secondary care, local government, people with lived experience as patients and carers, and VCSE. The first two workshops were conducted online while the third had both online and in-person options. Each workshop consisted of several breakout groups, with group constitution pre-determined to ensure a mix of stakeholders.

The workshops were structured based around developing the ToC, starting with initial discussion of what NbH means to people and the barriers and facilitators to delivery of NbH (Workshop 1),

 then how NbH would work and how would it be known that NbH works (Workshop 2),

 followed by member-checking the ToC and informing evaluation design (Workshop 3).

 

 Break-out group discussions moved iteratively between general NbH to specific factors of NbH. All discussions were audio recorded and online messages during discussions were used to support analysis. Additional data sources, including the 10YHP, were used to support analysis. Analysis and development of the ToC was iterative, moving between: 1) development of an overall theory of change at a more abstract level, 2) identifying more practice grounded ‘pillars’ of NbH that supported the overall theory of change.

 

Results: Over 100 participants contributed to the process of co-designing an evaluation of NbH. Within each workshop, breakout groups ranged in size from 4 to 8 participants. Drawing on workshop discussions and other data sources, the ToC was developed around six pillars of NbH: 1) Estates, 2) Funding/Financial Flows, 3) Workforce, 4) Data and Digital, 5) Integration and Partnerships, and 6) Patient/Carer

 

Expectations. The ToC explains the contexts and mechanisms, activities, and outcomes (short-term and long-term). For example, within the data and digital pillar, data sharing was identified as a major component of NbH with multiple activities. An activity example was to incentivise patients to share data, with impacts of this activity assessed by measuring opt-ins/outs and staff feedback.

 

Implications: Integration of people and services is central to successful NbH. This presentation will discuss how key pillars of NbH were identified and co-design activities were used to examine and develop of a unified ToC and how this could be transferable to other health systems considering or delivering large-scale system change similar to NbH. As the policy and delivery environment of NbH develops over the coming years, the ToC will be refined to inform tangible ways of understanding whether NbH is achieved.