We hear it all the time in reports and policy briefings about our cities and towns: there's ‘too much variation', a ‘lack of maturity', or ‘capacity issues'.

At first glance, these phrases sound technical, almost neutral. But look closer and they carry a quiet accusation: if only communities were more ready, more capable, more compliant, the model would work.

After years working in neighbourhoods across the North East, I have come to a different conclusion – neighbourhoods don't fail – systems fail them.

Limits of top-down models

Much of the thinking about neighbourhood health assumes a simple equation – design the delivery architecture correctly and place will follow. That logic underpins many NHS-led initiatives, from integrated care pilots to local health hubs. On paper, it makes sense. In practice, it fails to match reality.

Neighbourhoods are not just units of service delivery. They are social, civic and political systems, shaped by history, identity and the interaction between people, place and power. In the North East, we see this in stark relief.

Take, for example, urban neighbourhoods in Newcastle or Sunderland, or former industrial towns like Blyth or Hartlepool. The challenges are not a lack of engagement or goodwill. People participate, volunteer and contribute insight. Staff are dedicated. Yet initiatives often stumble, not because communities are failing, but because the systems around them are not designed to let them succeed.

Many NHS-led programmes give neighbourhoods complex responsibilities without authority. National rules dominate decision-making. Budgets are fragmented. Priorities are set far from the places expected to deliver them. And, when councils are treated as ‘supportive' rather than essential partners, neighbourhoods are left trying to thread together outcomes they cannot control. The result is predictable: pilot programmes collapse, expectations are unmet and communities are blamed for problems they did not create.

Lived experience and wellbeing

One of the enduring lessons from wellbeing work is that people experience the state, not as strategies or policies, but as places. Streets, estates, parks, GP surgeries, youth centres – these are the settings in which wellbeing is produced. When these environments are under strain, when transport links are poor, housing is inadequate, or community services are under-resourced, health outcomes suffer.

In the North East, the legacy of deindustrialisation continues to shape neighbourhoods. Job loss, entrenched poverty and social fragmentation have not only economic but psychological and civic consequences. Communities that are vibrant, resourceful and resilient on the ground can still be classified as ‘challenged' in national statistics. The mismatch is obvious: lived experience tells one story and systems' assessments tell another.

Wellbeing is not delivered, it is produced by the interaction of people, place and power. Yet too often, interventions are designed as if wellbeing were something to be handed down from an NHS boardroom. This top-down model fails to account for the local dynamics that make neighbourhoods thrive.

Why local government matters

Neighbourhoods do not exist in isolation. Their health is shaped by the policies, powers and priorities of local government. Councils control the levers that determine whether wellbeing can flourish: housing quality, planning decisions, transport networks, cultural and green infrastructure, economic development and community safety.

But in too many health-focused programmes, councils are positioned as peripheral. They are invited to ‘support', but not to lead. And yet, in the North East, where governance structures are complex and resources stretched, local authority leadership is not a luxury – it is structural. Without the council's authority to co-ordinate across sectors and direct resources, neighbourhood initiatives are patchwork and fragile. It is not a question of commitment or capability. It is a question of power and accountability.

Participation without power

Participation has become a buzzword in public service reform. Workshops, consultation exercises, citizen panels – all of these are valuable. But participation without authority is not empowerment, it is extraction.

Communities can provide insight, but they cannot deliver systemic change unless they are entrusted with real decision-making power. Otherwise, engagement becomes performative. Citizens are asked to contribute, yet have little ability to influence outcomes. Neighbourhood teams are tasked with integration but cannot align budgets, rewrite rules, or make policy decisions. The result is frustration on all sides – staff, residents and political leaders alike.

Wellbeing, then, is political. Place is political. And neighbourhoods are political. Any model that ignores this reality will continue to misdiagnose the problem, labelling communities as deficient when the real issue lies in the systems around them.

The North East offers clear examples of both the challenge and the opportunity. Consider Blyth, which has seen significant investment in port infrastructure and energy innovation. The potential for economic renewal is enormous. Yet local wellbeing initiatives can struggle to take root when governance structures are complex, resources fragmented and local voices marginalised.

Similarly, Newcastle's neighbourhood teams are often at the forefront of innovation in health and social care, integrating mental health support, social prescribing and community initiatives. But without the authority to shape budgets, planning, or broader policy frameworks, their impact is constrained. Residents know it – they see the enthusiasm of frontline teams and the limits imposed by systems that refuse to adapt.

Even in rural areas, the same patterns emerge. Integrated services in Northumberland or County Durham are often hampered by geography, infrastructure and decision-making frameworks that prioritise efficiency over local nuance. Neighbourhoods carry the burden of complexity they cannot control.

Redesigning the system

If we are serious about neighbourhood health in the North East, three shifts are unavoidable:

1) Shared place leadership – NHS systems and local authorities must co-design rather than defer. Leadership should be structural, not tokenistic.

2) Devolved authority – neighbourhoods must have the ability to adapt rules, pool budgets and shape priorities in ways that reflect local realities.

3) Honest system appraisal – stop blaming communities for failing outcomes. Acknowledge where national and regional systems constrain local action.

These are not incremental tweaks. They are fundamental shifts in how we think about power, accountability and the production of wellbeing.

Until these changes happen, wellbeing strategies will continue to falter in the very communities they are meant to support.

Neighbourhoods are ready to lead. Systems need to catch up.

Nick Kemp is an independent councillor at Newcastle City Council and a former leader of the council