This blog was written by Merron Simpson, CEO of The Health Creation Alliance with contributions from members of THCA’s Cross Sector Lab and Ambassador Team:* Debs Thompson, Lisa Holden, Kavita Gaur, Moneeza Iqbal, Ruw Abeyratne and Warren Heppolette.
A Blueprint 1.0 for Health Creating Neighbourhood Health
In mid-February 2026, The Health Creation Alliance (THCA) published its Blueprint 1.0 for Health Creating Neighbourhood Health
Bringing some clarity for those who want to actively reduce health and social inequity, it was drawn up by 11 individuals working across a range of professional sectors, and looking predominantly through the community lens, convened by THCA. Each brought a different perspective and all were committed to generating an accurate representation of Health Creating Neighbourhood Health – one that sets the conditions for people and communities to be better connected, more confident, in control of their lives and environments and actively participating, as equal partners and in a range of ways, in their own and their communities’ health outcomes.
The Blueprint 1.0 reclaims the language of ‘health’ – making it the central shared aspiration and endeavour across many services, sectors and communities rather than a description of a sector-specific service. It seeks to address the social injustices that cause avoidable ill health and focuses on the 80% of factors outside of healthcare that influence healthcare demand and health outcomes, without diminishing the 20% of interventions relate to healthcare. It sets out three purposes: health creation, prevention and healthcare – with health creation processes enabling all three.
Crucially, it centres community agency achieved through community strengthening, reciprocity and power-sharing, rather than hospital waiting lists and admissions, as the real measure of sustainable success.
The Blueprint has gained significant attention from many who have been looking for such a vision and approach … although for some community leaders and people with lived experience of poverty, trauma and discrimination, it does not go far enough. Community conversations and lived experience leaders need to be embedded in all stages of neighbourhood health evolution; we have dubbed the Blueprint 1.0 for a reason.
DHSC’s Neighbourhood Health Framework – how does it compare?
Five weeks after we published the Blueprint, DHSC and NHS England published their Neighbourhood Health Framework
The Framework presents principally a ‘healthcare vision’ centred around five national NHS-related minimum goals and three NHS ‘reform agendas’ for ICBs – improving routine healthcare, strengthening proactive care and providing better alternatives to hospital care. While ‘hard messaging’ is sometimes used to align with political promises, it can also reinforce the status quo. The language, concepts, requirements and outcomes used do not speak directly to the local authorities and voluntary and community sectors the NHS is keen to co-opt as key partners. In this sense, it does not truly help to dissolve barriers or promote reciprocity to achieve integration, shared endeavour and cohesion between the NHS, local authorities, VCFSE, communities and other statutory and community partners.
The main ambition is for services to be better shaped around specific communities and cohorts – frail older people, people living with long-term conditions, children and young people, people who have cancer. For each of these, there is scope to broaden pathways beyond the clinical to include social elements as well, and to make a decisive shift from deficit-based to strengths-based thinking and approaches. Why keep referring to ‘vulnerable older people’ when we could all aspire to ‘valuable older people’ living their best lives until the end? Health creation is a route to achieving this shift in perception and reality.
An enhanced ‘place-leadership’ role for Health and Wellbeing Boards – to set the local strategic direction, support integration across social care and public health, provide community insight and democratic legitimacy – could also go further in creating collective leadership for change. Shared decision-making for how system resources are spent would bring it closer to the ambitious cross-sector, community-inclusive governance envisaged in the Blueprint 1.0. While the NHS continues to hold all the purse strings, a necessary shift in the balance of resources towards the creation of health and upstream prevention will remain elusive. Place-based partnerships are the closest the Framework comes to this although it does leave space for locally developed aims and more flexibility in local design and delivery. The Better Care Framework 2026/27, published in February, could also support evolution in place-based partnerships through dedicated resource for integration, including through joint commissioning. So the stage is set for those who want to, to go much further and it will be interesting to see how this space develops going forward.
What are the prospects for health creating neighbourhood health?
While Neighbourhood Health is in its infancy, there have been shifts towards a health creating version to reduce health inequity for many years. Aided by the work of many organisations, including THCA, and national programmes such as Core20PLUS5, the National Neighbourhood Health Implementation Plan (NNHIP) and notions of participative democracy and community power, understanding is growing and the appetite is now strong.
Significant challenges remain, not least the non-alignment of power, accountability and trust. There is some evidence that enhancements are made in power-sharing, accountability to communities and trust where Neighbourhood Health is seen principally as an exercise in listening to communities and reworking public services accordingly (rather than as a geographical footprint for service delivery).
Why does the term ‘system integrator’ refer to the provider of the service (SNP, MNP, IHO) rather than to a sector-spanning convenor that prioritises community insight and brokers enhanced collaboration? The workforce cultural transformation piece remains under-cooked, but it is critical. It is exciting to see some Mayoral Combined Authorities finding their way into this space and seeing it as their role to provide the leadership, governance and direction to see this through. Not only this but programmes like Pride in Place and shifts in social finance (and the ‘impact economy’) could all help to change the landscape and support a more health creating version of neighbourhood health to gain ground.
What is needed now is much greater authenticity in system-community relationships, starting with senior leaders. Communities give and ask for reciprocity but are frequently denied it when power-holders see systems falter and over-estimate their role in putting things right. Communities want to be both heard and respected. This means having intentional, deliberative conversations with people who are not heard, giving them the space and financial means to define, create, sustain and develop something of value to them. This is what we mean where our Blueprint 1.0 says ‘Neighbourhood commissioning shifts resources, maximising community … contributions for health creation and prevention’. It goes beyond engagement with the established voluntary and community sectors. Communities need to be respected for their contributions, trusted with money and invested in to make the things that matter to them happen.
Making a breakthrough
The ideological tension between the medical vs the health creation model remains vivid. While the healthcare vision continues to dominate the national guidance something else is happening on the ground. The voice of health creation leadership is growing louder and routes are being found that start with community connections, relationships and equal partnerships.
How far this can go without radical national-level reform remains to be seen. For now, it is both possible and judicious to twin-track – to meet both national requirements in the Framework and to build community agency through the health creation approach. But it is that latter that will unlock the huge potential of communities and other local partners to make NHS recovery possible, by becoming true partners in a new ecosystem of provision that embraces and prioritises health creation.
* Contributors
Dr Deborah Thompson, Consultant in Public Health
Lisa Holden, Health Creating Public Involvement & Community Engagement Worker
Dr Kavita Gaur, GP
Moneeza Iqbal, Director of Integration and Provider Collaboration, Oldham Integrated Care Partnership
Dr Ruw Abeyratne, Director of Inequality and Inclusion, University Hospitals of Leicester
Warren Heppolette, Director of the Prevention Demonstrator, Greater Manchester Combined Authority
