Asked why Macmillan is in the neighbourhood health space, McLean said: ‘Cancer is so prevalent, it's such a big system challenge, that neighbourhood health is a really interesting opportunity.

‘Cancer gives us a powerful lens through which to understand some of the fragmentation and lack of joined-up care that exists across the wider health and care system. If we can demonstrate what better, more connected care looks like through cancer, there is potential for that learning to benefit people much more widely.

Macmillan has committed to invest £250m in neighbourhood health across the UK over the next three to five years, through a range of programmes designed to support more joined-up, community-focused care closer to home.

The charity has also launched its CARE (Culture, Agency, Respect and Equity) Grants Programme, investing more than £7m in 65 community-led projects across the UK to help address persistent inequalities in cancer care.

The programme recognises the important role community organisations can play in shaping services around people's needs and experiences, particularly for communities facing the greatest inequalities.

 Alongside this community-led work, Macmillan is also investing in established local partnerships to support change across the wider health and care system. This month, Macmillan launched its Collaboration for Better Cancer Care Grant, with grants available between £100,000- £500,000

‘This is for established partnerships with people and systems who have got great ideas around how they want to improve cancer care in their area,' McLean explained.

‘It is a place-based collaboration where people say, "we think we can do something different here".'

Trailblazer Programme

Perhaps most significantly, the charity has launched its innovative social investment Trailblazer Programme. The six new Trailblazer sites build on Macmillan's existing experience of social investment in health and care, with over £36m invested in palliative and end of life care and recent investments in new Neighbourhood Transformation funds including investments in West Hertfordshire, Dorset and Lincolnshire. Explaining the idea for the programme, McLean said: ‘We've seen the appetite for social investment, for example, in young people's services, in prison services and maternal health; and in Macmillan's experience, in improving the experience of people in their last year of life and driving savings in health care systems on reduced bed days.

‘So, we know there is an appetite there, and we're really hoping that Macmillan's brand, experience and partnerships will give others confidence to understand and to learn more, and that we can bring others along.

‘This is thinking about how can we improve support for communities that are facing the greatest barriers in accessing care and really thinking about how we can collectively create the conditions for change to deliver things differently, Macmillan are stepping into the space to give the headspace and absorb some of that upfront innovation risk whilE new services and ways of working are redesigned and tested.'

Macmillan is intending to act as a cornerstone investor in the Trailblazer sites, helping to attract other partners and investors and increase funding available to transform care closer to home. 

Investment criteria

In terms of criteria for choosing the six sites, McLean said: ‘We have really focused on partnerships that can deliver system-level, neighbourhood-based services rooted in local need, joined-up personalised care, measurable outcomes and a clear focus on reducing health inequalities through community and VCFSE co-design.

‘We were looking for applicants that could show they have the leadership, financial commitment, data capability and programme capacity to develop and drive investable propositions, including support from their ICB executive sponsor and the organisation responsible for repaying investors.'

The director added Macmillan had also looked for a diversity in types of projects.

‘We didn't want six identikit projects; we wanted a real spread of approaches and areas of the country,' she stressed.

‘Having a diverse range of approaches gives us a much richer opportunity to learn what works in different places and for different communities.

‘The sites are exploring a range of approaches, from digital interventions and prehabilitation to supporting people living with frailty and of course looking for that connection to people living with cancer. Each is looking at the challenges facing its local population and how partners can work differently together to address them.'

McLean said community involvement was also an important part of the criteria, helping to ensure approaches consider people's wider needs and experiences, rather than focusing solely on clinical care.

She also stressed the importance of securing commitment from both clinical and financial leaders within local health systems: ‘From our previous work in palliative and end-of-life care, we know that having that wider system commitment is vital if you want to turn good ideas into sustainable change.'

McLean added the charity hoped to see many more local authorities as partners in place-based work and driving projects over the next three to five years.

Macmillan is supporting the six Trailblazer sites through an initial development programme, working alongside Social Finance to help local systems develop their approaches and build the capability and partnerships needed to sustain and scale change.

‘We are investing significantly because we want to have a system wide impact,' McLean explained.

‘It's intended to be genuine system transformation.'

The new six sites come in addition to a £40m investment in three neighbourhood health sites already up and running in West Hertfordshire, Dorset (see below) and Lincolnshire.

 ‘They are all slightly different models, but broadly they are focused on supporting people with more complex needs, including people living with frailty, and helping people stay well for longer. That includes providing more proactive, joined-up support in the community to help prevent crises and avoid unnecessary hospital stays,' McLean noted.

IN NUMBERS - Dorset Trailblazer   Overall activity was below forecast across both planned and unplanned care in the first six months. Emergency attendances were 1.7% below forecast, with emergency admissions 3.4% lower. Elective admissions were 4.5% below forecast, reflecting reduced planned care activity. Outpatient attendances were 7.5% below forecast, the largest reduction across the main activity measures.

Outcomes-based funding

Macmillan's social investment approach is outcomes-based, with funding structured around achieving agreed improvements for people and the health and care system. The specific outcomes will vary between sites and will be agreed as part of each investment.

‘The outcomes need to be meaningful enough for the patient or the person living with cancer in the middle of the programme but also is measurable for the system and that we can show an economic benefit on,' McLean explained.

‘They will all be slightly different and this will form part of the contract at the start of the funding period.'

Macmillan is prepared to take on some of the financial risk involved in testing new approaches, giving local systems greater space to innovate and build the evidence for doing things differently.

‘It gives people the time and space to try something different, which can be incredibly difficult within the health and care system,' McLean said.

‘The aim is to create the evidence for approaches that work, so local systems can make the case for sustaining and scaling them over the longer term.'

The charity sees outcomes-based funding as an impactful way to unlock innovation.

‘It gives people a space to have the time to try to do something different which in the health and care system is so hard to do,' McLean explained.

‘You just don't have the time to prove the outcomes. We see outcomes-based funding as giving the opportunity to almost double run, and to go "yes this works we take the risk".

‘If it doesn't work they don't repay it, and if it does work, they've got their business case going forward.'

Over the next couple of years, Macmillan is keen to identify other funders to support the programme.

‘We can really see how social investment can work for so many other conditions and so we're really keen, whether that's other third sector organisations, philanthropists, or statutory partners to attract other funding,' McLean noted.

Aligned neighbourhood health

I was interested to learn how Macmillan's programme aligned with the Government's Neighbourhood Health Implementation Programme (NHIP) which aims to launch 250 neighbourhood health centres across England by 2035.

‘We worked really closely to align with leaders across the NHIP to really think about how our neighbourhood transformation funds and the Trailblazer Programme learn from and strengthen the work underway with NHIP with NHIP,' McLean said.

The charity director said each of the six new sites had an element of alignment with local NHIP sites.

‘We would expect an element shared learning with the NHIP programme sites,' McLean observed. ‘We don't want this transformational work to operate in silos.

‘We think neighbourhood health centres are a really important part of neighbourhood health.

‘But for us, neighbourhood health is so much more than a building. It's about those relationships, really different ways of working, and that's part of what we're trying to do in some of our work within and beyond social investment.'

Macmillan is also partnering with Q, hosted by The NHS Alliance, to deliver the Macmillan Q Lab; a nine-month programme working with six to 10 local areas to bring health and care services, communities and people with lived experience together to explore how holistic cancer care can be delivered closer to people's homes.

Neighbourhood health conduit

Summing up, McLean said: ‘What Macmillan is really trying to do is to combine both its brand and its presence, its ability to bring communities and people with lived experience, the NHS and Government partners together, and with its funding capability and ability to attract other funders to really provide a that neighbourhood shift in care closer to home.

‘We believe Macmillan can be an important conduit and instrumental in ensuring this leads to better co-ordinated care for people living with cancer.'