I spoke to Kirby as his role as NHSE's national adviser for neighbourhood health was about to come to an end in March as part of NHS reorganisation. 

Looking back on his adviser role, Kirby said: ‘It's been really helpful to be able to provide  some community service input into the thinking about what neighbourhood health services might mean, about the structures you need to make them work well and the sort of policy change and policy measures that will achieve that, and maybe some of the things that might get in the way,' he noted. 

The chief executive said the National Neighbourhood Health Implementation Programme (NNHIP) across 43 sites launched last year had been ‘really helpful' in delivering a  ‘bottom-up approach'. 

Under NNHIP, each site was given a programme lead and asked to form a neighbourhood health team consisting of community nurses, hospital doctors, social care workers, pharmacists, dentists, optometrists, paramedics, social prescribers, local government organisations and the voluntary sector to give people access to the right care on their doorstep. 

Integrated neighbourhood teams 

Birmingham Community Healthcare has worked with partners in the ICS to pioneer neighbourhood health through integrated neighbourhood teams, which are multidisciplinary teams providing better joined up care for the highest health and social care users. 

Kirby said he envisaged full coverage of Birmingham and Solihull would require over 30 teams, adding 11 were already up and running. 

‘We plan to get the remainder up and running through 2026/27 working closely with partners and with continued support from ICBs as commissioners,' he noted. 

Locality hubs 

The trust's second pioneering initiative has been its locality hubs, again developed in partnerships with other providers, serving populations of 250,000-300,000. 

Kirby said he ultimately envisaged two or three hubs acting as neighbourhood health centres with integrated health teams. 

‘We've a way to go to get to that point, including making sure that we can adapt the estate we've got to enable that to happen,' he acknowledged. 

Kirby said Birmingham had some very good Local Improvement Finance Trust (LIFT)-based, relatively modern, primary care estate that can be used as neighbourhood health centres, which some of the money announced in the Autumn Budget would fund. 

In addition, the trust has invested some of its system capital with the support of the Birmingham  and Solihull ICB in the redevelopment of facilities, such as Sutton Cottage Hospital in north Birmingham. 

Highlighting progress on expanding hub services, Kirby said the locality hub in East Birmingham had already attached a community diagnostic centre, as well as outreach secondary care services delivered by clinical teams from Heartlands Hospital. 

Given the Government envisages neighbourhood health centres serving a population of around 50,000, however, Kirby said he hoped this was one area there will be space for flexibility to cater for local situations.

Community partners 

The chief executive said building a much stronger set of relationships with GP practices and GP provider organisations was key to establishing a successful neighbourhood health model. 

The trust's Community Care Collaborative for Birmingham and Solihull has provided the basis for bringing multidisciplinary partners together. 

‘If people are having debates about who's in charge of neighbourhood health, they're missing the point, you can't have a single person in charge of what has to be a partnership endeavour,' Kirby observed.

‘Everybody brings something really important. The community services have a role to play. GPs have an important role and we can't do this without the acute hospital workforce being a really important part,' Kirby added, indicating the six localities in Birmingham and Solihull have SROs drawn from different NHS organisations.

Stressing the importance of incorporating mental health, Kirby noted Birmingham's mental health trust had been one of the pilot sites for the 24/7 neighbourhood health mental health care model. 

Kirby said neighbourhood health could not work without really strong input from social care. 

‘From early on, we shared our vision of the neighbourhood model with social care,' he said, indicating social care data had been used to identify high service users. 

‘Some of our intermediate care teams are working across health and social care because it helps us all if we can get people out of hospital early, provide a good model of rehabilitation and re-enablement and get them home with less ongoing social care,' Kirby explained. 

He said the trust's Community Connexions engagement programme was also key to ensuring effective neighbourhood working and meeting the needs of the local population. 

The challenges 

In assessing the challenges to delivering neighbourhood health, Kirby said it was important to strike the right balance between national frameworks and local initiatives and local responsiveness. 

‘The way we deliver integrated neighbourhood teams in inner city Birmingham is different from the way they are delivered in very rural places and  every place needs to work through its own model,' he emphasised. 

In addition, Kirby said getting the right practical support for the programme, such as data sharing agreements, was key. 

He said there were still ‘big questions' around how money will flow to neighbourhood teams and neighbourhood services. 

‘This is not as simple as if only you could shift money from one organisation or one part of the system to another, because we've all somehow got to find a way to make better use of the money we've got,' Kirby said. 

‘That's quite complicated to do but it's going to have to be part of this solution somehow,' he stressed. 

Kirby said strategic commissioning was crucial to getting to grips with the question of investing in provision in the community without destabilising acute services in a way that delivers a better overall model.

Turning to the workforce, the chief executive said setting up neighbourhood health teams was not necessarily about adding lots of new people but more a case of altering the working patterns of existing local staff. 

‘It's about helping people who are already in our teams work in a way that is more multidisciplinary, collaborative, that increasingly use and share data, all the things the 10-Year Plan talks about,' Kirby said. 

Better outcomes 

Summarising the trust's neighbourhood health outcomes, Kirby commented: ‘We are seeing the people on the integrated neighbourhood team caseload visiting their GP and attending ED less frequently. 

‘And we're seeing the long-stay hospital cohorts, the care co-ordination teams and in-reach teams are working with reducing their use of hospital bed days.

He acknowledged there was ‘still a huge way to go', however, adding: ‘We've still got real emergency care pressures in the acute sector in Birmingham, as anyone who looks at the data will see.' 

The way ahead 

Kirby said the Government's target of having 120 of 250 neighbourhood health centres operational by 2030 was achievable but cautioned some parts of the jigsaw would fall into place faster than others. 

The chief executive noted early progress on data sharing, adding the programme was going in the right direction on estates. 

He said neighbourhood health centres could learn from Family Hubs by being much more multidisciplinary across the wider public sector, citing how they address benefits, the criminal justice system, education and training for young people. 

‘Some of the adult neighbourhood health thinking has tended to focus more on the here and now problem of lots of people needing hospital care,' Kirby reflected. 

While acknowledging previous failed attempts at neighbourhood health, Kirby said he was optimistic it could work this time, before cautioning one of the main challenges would be demonstrating how it can tackle short-terms problems as well as building a better long-term future. Kirby said attempts to build teams to take a holistic neighbourhood view of healthcare in Denmark and the Netherlands, for example, demonstrated other nations were taking the same approach. 

‘I think you've got a moment when there is a proper chance to make something work differently, to do what lots and lots of people in the service have been wanting to do for some for some time,' he concluded.