Improvement as infrastructure: case studies in neighbourhood health

The core ambition for neighbourhood health is that care is delivered closer to home, shaped by the people who use it, and supported by systems that enable collaboration. 

Across some of Q’s funded projects, we see common threads that show what it takes to make that neighbourhood health ambition real – and how improvement helps (see also How improvement approaches can support neighbourhood health models). We also see consistent barriers these teams have faced to longer-term structural changes and implementation. 

The impactful case studies we share below all demonstrate important lessons and insights. Across these initiatives, improvement acted as the infrastructure for change: enabling collaboration across organisational boundaries; supporting shared understanding of local needs; and creating feedback loops that allowed teams to adapt models of care as learning emerged. 

Integrated neighbourhood teams require multiple organisations to work together, including primary care, local authorities and voluntary sector partners. 

Making this collaboration effective across different cultures and operating models depends on balancing the NHS’ often dominant ways of working, with local community approaches, and developing a shared language for the work. 

In Harrow, a neighbourhood‑level improvement initiative focused on children and young people experiencing mental health crisis brought together primary care, local authority services, acute care, and academic partners. Their work addressed fragmentation across organisational boundaries that often leads to delayed or inappropriate responses in crisis situations. 

Using improvement methods, the team mapped complex, real-world journeys of children and young people with mental health needs as they move between services. 

A key learning was the lack of shared language between organisations, such as how different groups understand the word ​“crisis”. Agreeing a joint definition created a shared base for when and how to collect data, enabling earlier identification of risk patterns and more coordinated responses. 

This work illustrates how neighbourhood health depends on building shared understanding across systems. This can be supported by improvement approaches that enable joint sense‑making, continuous learning and data‑informed action. 

Neighbourhood health thrives when frontline teams and communities can act on what they know. A report from King’s Fund advocates for community partnerships being at the heart of neighbourhood health. The work should not be top-down, but rather use distributed leadership, enabling and supporting frontline teams to lead and develop solutions. 

In Q’s work supporting improvement, we have seen a wealth of examples of people working on local health challenges, offering useful lessons for neighbourhood health shifts. 

Across multiple neighbourhoods, a primary and community‑based improvement programme tested how small amounts of flexible funding could support frontline teams and community partners to address locally identified health challenges. This improvement micro-funding programme across Cheshire and Merseyside showed how small amounts of flexible funding could support frontline teams and community partners to address locally identified health challenges. 

The project used funding from our Supporting Q Connections programme to give £1,000 to 20 local teams who saw a need and had the relationships to catalyse change. The programme focused on enabling teams to test ideas, gather feedback and adapt. 

The initiatives ranged from social prescribing for patients waiting for mental health support, emergency care packs for stabbing victims, to greener deprescribing initiatives. 

Improvement support helped teams use simple cycles of planning, testing and reflection. They deliberately avoided jargon to keep learning accessible and aligned with everyday practice. 

This approach enabled shifting power closer to communities, supporting locally led improvement while maintaining a shared discipline for learning, evidence and accountability. 

The delivery of neighbourhood health centres will involve setting up new spaces and services for local communities. This will involve developing new models of care and ways of working, identifying and adopting best practice from across the sector. 

In Sheffield, a neighbourhood‑based mental health service (Psychiatric Decision Unit) was established to offer a 24/7 alternative to accident and emergency for people in crisis. Despite clear demand, the service was under‑used, prompting a structured improvement effort focused on access, experience and inclusion. 

With the support of Q Exchange funding and working with people with lived experience and voluntary sector partners, the team used iterative testing to understand barriers to use. 

Feedback revealed that uncertainty about the environment and concerns about safety and inclusivity limited uptake. Changes were tested and refined, including clearer public information (photos and frequently asked questions about the facilities on the website) and adaptations to the physical space. 

This example shows that neighbourhood health services require ongoing learning after implementation. Improvement approaches help teams use real‑time feedback to adapt services, so they are accessible, trusted and responsive to local communities. 

Neighbourhood health is about creating new models that work for patients and practitioners. 

Supported by Q Lab, enhanced primary care hubs at the South Docs Services GP Federation in Birmingham redesigned a specialist care pathway so that more people could be treated within primary care rather than referred to hospital. The work focused on building multidisciplinary capability in the community and redefining how primary and secondary care work together. 

Using improvement approaches, the service tested new staff roles, set clearer guidance for when patients should be referred to hospitals, and worked more closely with hospital specialists. As a result, ongoing data and feedback loops showed that the majority of patients could be safely managed in the community, reducing waits and improving experience while maintaining quality. 

This work demonstrates how neighbourhood health is enabled by pathway‑level redesign, and supported by evidence and continuous learning, rather than a simple relocation of services. 

While Q‑funded projects demonstrate what is possible through neighbourhood level improvement, they also consistently surfaced a systemic barrier to progress. 

Current commissioning and finance models (including those proposed for neighbourhood health) often prioritise hospital-based activity, as identified in this Kings Fund report. This makes it difficult to grow primary and community‑based provision where this is perceived as diverting resources away from secondary care. 

Across multiple projects, this misalignment constrained the ability to redesign pathways at neighbourhood level, even where there was strong evidence of improved access, outcomes and experience. 

Improvement approaches helped teams generate and test this evidence locally, but without supportive commissioning and financial mechanisms, scaling and sustaining change remained challenging. 

These insights suggest that commissioning and finance must: 

• reward prevention and integration, 
• enable collaboration across organisational boundaries, and 
• direct resources to where they have the greatest impact on patient outcomes. 

Without a stronger financial commitment and enabling structures, neighbourhood health ambitions focused on a ​“left shift” risk resulting in a ​“right drift” instead, as described in analysis from the Health Foundation. 

Ultimately, this means reinforcing acute‑centric models rather than transforming pathways. 

The Neighbourhood Health Framework, published in March 2026, offers some much-needed clarity. However, it remains deliberately permissive and leaves many questions about capacity, funding and priorities unresolved. 

Across Q‑funded projects, we saw clear evidence that improvement approaches help neighbourhood teams navigate this uncertainty. 

Improvement provides a structured way to collaborate across boundaries, generate and use evidence, and create feedback loops that allow services and pathways to adapt over time. 

However, improvement mindsets and approaches remain uneven across primary and community care – the very foundation on which neighbourhood health depends. 

Recent system-level analysis suggests that improvement should be treated as core neighbourhood health infrastructure, enabling teams to deliver neighbourhood health safely, iteratively and responsively. 

Learning, evidence and adaptation cannot be add-ons; they are essential to making new models of care work in practice. This is especially true in complex, multi-agency neighbourhood systems. They also make sure teams can make the best use of available resources. 

For neighbourhood health to succeed, sustained investment in improvement capability across primary and community care is essential. Initiatives such as the Royal College of General Practitioners’ improvement resources show what is possible. 

Wider progress depends on leadership, working with existing teams’ strengths, and embedding pragmatic approaches to measurement and evaluation that support continuous learning. 

Neighbourhood health is not a single intervention – it’s a way of working. 

Q members are showing that improvement is the bridge between ambition and reality. The challenge now is to take these lessons and embed them at scale, so that neighbourhood health can move from policy intent to embedded practice and collaborative care closer to home.