Developing an initial Theory of Change for Neighbourhood Health to inform future evaluation

Background / Context
Establishing a ‘neighbourhood health service’ is central to the NHS 10 Year Health Plan for England (10YHP), which lays the groundwork for more community-focused healthcare provision by moving care out of hospitals and into neighbourhoods through integrated neighbourhood care models. Integrated care models are not new; however what is new about Neighbourhood Health (NbH) is the ambition to implement these models across England as part of a ‘cultural change’ in the way health and care services are delivered and used. Despite policy intention, it is currently unclear how this integration and NbH more generally is intended to work. In this presentation we will describe an initial Theory of Change (ToC) for NbH developed during the co-design of a national NbH evaluation.

Methods
A series of three co-design workshops were conducted in Autumn 2025, with participants representing a variety of stakeholders: Integrated Care Boards, NHS primary and secondary care, local government, research and policy experts, people with lived experience as patients, carers, and voluntary/community sector organisations. 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 explored meanings of NbH and factors enabling or hindering its delivery (workshop 1); the activities and strategies needed to deliver NbH, short- and longer-term outcomes and how these could be measured (workshop 2); and criteria for case-study site selection and knowledge mobilisation activities (workshop 3). Discussions were audio recorded and online messages during discussions used to support analysis, which also included drawing on policy related to NbH such as the 10YHP. Analysis of the data and development of the ToC were iterative, moving between: 1) development of an overall theory of change at a more abstract level, and 2) identifying more practice grounded ‘pillars’ of NbH that supported the overall theory of change.

Results
A total of 110 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.

Limitations
The initial ToC was developed with considerable stakeholder involvement but is not yet sufficient for evaluating NbH at a national level. There remains a large amount of uncertainty about what different models of NbH may look like, with wide variation in design and delivery based on local and regional needs of the population.

Implications
Key pillars of NbH were identified via a robust co-design process, including an understanding of how they may contribute to an initial ToC of NbH. As the policy and delivery environment of NbH develops over the coming years, the initial ToC will need to be refined prior to testing in a national evaluation. Input from reviews of the current evidence base of published and grey literature, and theories, on integrated care relevant to NbH will inform the refinement and subsequent testing of programme theories as part of the national evaluation, with lessons for local and regional evaluations also discussed.