National Evaluation of Neighbourhood Health

Background Establishing a ‘neighbourhood health service’ (NbH) 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 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. However currently, NbH is poorly defined. As a complex policy intervention, NbH spans multiple sectors, including health and social care, voluntary and community organisations and wider public services. Additionally, models of NbH will be locally determined and, therefore, there will be wide variation in design and delivery. The IDEAS National Evaluation Team (IDEAS-NET) has been tasked by the Department of Health and Social Care (DHSC) with conducting a national evaluation of NbH. This evaluation has been informed by and builds on previous work that sought explore and understand stakeholder perspectives of what NbH means to them; the activities and factors that might help or hinder its delivery; and implications for evaluation design. Aim To undertake a theory-led pragmatic evaluation of NbH that generates explanations of what works, for whom, in what circumstances, and why. This will be via a targeted examination of how NbH is designed, organised and delivered. Methods The evaluation will adopt a realist approach to evaluate how NbH works, for whom, in what circumstances, and why, conducted over a three-year period from April 2026. Realist evaluation is theory-driven and well suited to embrace and explain the inherent "messiness" of real-world programmes and evaluations in complex systems. By acknowledging the context (i.e. features of the conditions in which phenomena are introduced), realist evaluation helps to identify how specific contextual factors enable or constrain mechanisms. In the evaluation of NbH, understanding how NbH may operate across different settings, by examining how contextual features shape the activation of specific mechanisms is particularly important where multiple pathways from implementation to impact are possible. A concurrent mixed-methods comparative case study design will also be used to evaluate the design, organisation, and delivery of NbH as it is rolled out across England. The core evaluation activities include a national survey to develop a taxonomy of types of NbH (ways NbH is designed, organised and delivered); a scoping review and series of high level (~30) and deep-dive (~10) mixed-methods organisational case studies to develop and test programme theories of how NbH works, for whom, and in which circumstances; and dynamic system modelling to simulate long term outcomes and funding flows for different NbH types. Whilst we will attempt to incorporate cost considerations and implications for funding flows into the modelling, it is not possible to construct a full economic model to support an analysis of cost effectiveness of NbH. The BEACON evaluation consists of five workstreams to meet the following objectives: 1) To identify and plan how we will involve and engage key stakeholders (including PPIE representatives) at all stages of the evaluation and share our findings with them throughout the evaluation (Workstream 1). 2) To construct a taxonomy of the different ways that NbH is designed, organised and delivered, including the historical, structural and relational contexts that underpin these different ways of working (Workstream 2). 3) To develop initial programme theories of how NbH may work, for whom, and in which circumstances, drawing on national and international evidence, formal theories, and stakeholder input (Workstream 3). 4) To identify data sources and measures for assessing range of medium- and long-term impacts of NbH for further modelling (Workstream 4). 5) To test and refine theories of how NbH works across different types of NbH in the taxonomy and across different geographies and demographics, recording how changes in local, regional and national policies can frame these findings (Workstream 4). 6) To simulate the refined theories to model the long-term outcomes and funding flows for different types of NbH in the taxonomy and identify plausible scenarios for testing in the ongoing evaluation and monitoring of NbH (Workstream 5). Evaluation outputs Outputs will include a taxonomy of types of NbH, refined programme theories and a refined theory of change of how NbH works, a user tool simulating the long-term outcomes and implications for funding flows for NbH, and implications for policy, practice and future evaluation. These will be disseminated through a range of outputs for different audiences including peer-reviewed publications, reports, and briefings. To maximise the value of this evaluation for policy makers, we will produce policy briefings at key time points during the evaluation (e.g., budgetary review periods, national and local government election periods, and the political conference season). Policy recommendations may be provided where applicable and appropriate.