Written by Georgina Gledhill (Account Director at Incisive Health) based on an interview with Thomas Britton, Principal (Contracted Employment Provision) and Working Well Programme Lead at Greater Manchester Combined Authority.
When Wes Streeting entered Victoria Street in July 2024, one of the first things he did (shortly after describing the NHS as “broken”) was to declare the Department of Health and Social Care an “economic growth department”. While links between health and wealth aren’t new, his comments represented a fundamental shift in the Department’s vision – moving beyond a department for public services, to a force for reinvigorating the economy.
It’s no secret that the Government face an uphill struggle on the economy and growth. Among the list of priorities is tackling the rising tide of long-term sickness, which has forced almost 2.8 million people out of the workforce. In this final part of our ‘neighbourhood health’ blog series, we speak to Thomas Britton from Greater Manchester Combined Authority (GMCA) to explore how one part of the country is taking a whole population approach to health, skills and employment, and what learnings can ensure neighbourhood health services support the wealth and health agenda.
Local leadership as the driver of meaningful change
There is a shared understanding across GMCA that Greater Manchester faces specific challenges, which services must be shaped around and seek to address. For example, Thomas noted that there is significant deprivation across the region as a whole, with some wards ranking among England’s most deprived. As such, ‘one size fits all’ offers that are ‘parachuted’ into local areas don’t stand to make a difference to the lives of local residents.
Local authorities’ broad remit means they are a key player in tailoring services across health and wellbeing, social care, education, housing and environmental health. Given their close proximity to local communities, including businesses and third sector organisations, local authorities are particularly well placed to understand what’s already working, develop targeted interventions and, in turn, shift the dial on inequalities.
However, as new models of care look to be established, it will be important to ensure they are underpinned by adequate investment (for example for local authorities through the public health grant). Clear expectations will also be important, particularly on roles and responsibilities, to support accountability measures. These can measure change within an area (like reductions in health inequalities) and ward against unwarranted variation at the national level.
Embracing devolution to support holistic approaches to wellbeing
In Greater Manchester, Thomas oversees the ‘Working Well’ programme, which is designed to support people with poor health who are at-risk of, or experiencing, long-term unemployment. The scheme began in 2014 as a pilot and has now been expanded through a series of devolution deals between central government and GMCA.
The Work and Health programme within Working Well offers health, skills and employment support – all via a single-entry point, meaning that people facing barriers to work and better health don’t need to navigate a complex web of services. Working Well shows that local devolution can create alternative pathways to care – wrapping services around individuals to prevent them from falling into a place where they need urgent care, which has costly implications.
Thomas acknowledged the value of GMCA’s coterminous footprint, which is shared with the Department of Work and Pensions (via Jobcentre Plus), as well as the Greater Manchester Integrated Care Board. These organisations are brought together by a shared set of values and principles, with integration and accountability baked into operational enablers, such as delivery frameworks, Integration Boards (attended by local services) and information gateways for data sharing. As a result, decisions can be made at a collective level, which serve to address the social determinants of health, while preventing repetition of work and effort – freeing up more time to make sure services are actually working for the people they serve.
Creating and protecting local flexibility
As we look towards a new way of organising services, there will need to be a fundamental shift in the relationship between local areas and central government. Thomas acknowledged that, while disruptive, the forthcoming merger of NHS England and the Department for Health and Social Care is an opportunity to decentralise decision making and look at how things can be done differently.
Success will require rethinking how value is measured. At present, decisions are driven by revenue generation, whereas shifting to prevention‑based policymaking would enable longer-term investment and protect funds from being continually diverted to acute, reactive care. Thomas highlighted that short evaluation timeframes – such as assessing impact after just six months – make it difficult to demonstrate value for money, reinforcing the tension created by electoral-cycle short‑termism. Ultimately, establishing a neighbourhood health service will depend on sustained political will and prioritisation in an already complex and crowded policy environment.
Turning ambition into impact
So, what does this mean for industry partners wishing to help make neighbourhood health services a reality? Here are three principles from our discussion with Thomas to keep in mind:
Look beyond traditional healthcare stakeholders to drive forward neighbourhood health models. For example, partnering with local and combined authorities to build local understanding and complement ongoing work to fill gaps where specific skills and knowledge from industry can provide support
Keep local realities and priorities front of mind to make sure industry partners are actually adding value for individual areas, rather than duplicating work or inadvertently contributing to a ‘one size fits all’ approach
Engage national and local policymakers by advocating for change in how commissioning bodies evaluate return-on-investment for services – helping to shift the dial on the value of investing for prevention