Delivering integrated neighbourhood services: commissioning and service design

Key messages

• current policy emphasises Place-level commissioning to support more integrated health and social care at neighbourhood scale, aligning with the 10 Year Health Plan’s shift towards community-based care
• Places are intended to be sub-Integrated Care Boards (ICB) geographies where integrated services are planned and delivered around local populations
• commissioning responsibilities were delegated through the Health and Care Act 2022 without prescriptive structures, leading to variation in local approaches to Place-level commissioning
• literature suggests factors that enable effective Place-level commissioning include clear governance, strong relationships, shared priorities, workforce capacity, pooled resources and collaborative planning
• there are recurring tensions between integration aspirations and the legacy organisational, structural and policy divides that continue to shape commissioning practice.

Policy implications

• commissioning systems need clarity on how responsibilities at Place level sit within wider Integrated Care Systems (ICS) structures
• effective neighbourhood health and care depends on governance arrangements that support collaboration rather than siloed action
• workforce development, information sharing and resource alignment should be prioritised in commissioning design
• national policy should continue to support local adaptation while providing frameworks that encourage consistency in integrated commissioning.

Gaps

• limited empirical evidence on how Place-level commissioning directly affects integrated service delivery outcomes
• variation in how neighbourhood and Place commissioning has been interpreted complicates comparison across local sites
• much of the evidence is early and descriptive, with limited long-term evaluation of integrated neighbourhood initiatives.

Commentary
This interim report provides early insights into how commissioning and service design are shaping integrated neighbourhood health and care in England. By focusing on Place-level mechanisms, it highlights how national policy intentions are being interpreted and operationalised in local systems.

The shift towards neighbourhood-based integrated commissioning is situated within broader NHS reforms, including the 10 Year Health Plan and statutory establishment of Integrated Care Systems (ICS). In this context, Place offers a scale at which health and social care services can be joined up around people’s needs rather than organisational boundaries.

Key enabling factors identified in the literature signal that commissioning for integrated neighbourhood care requires more than structural arrangements; it depends on trust, shared priorities, effective governance and aligned incentives. These relational and organisational elements mirror themes seen in other neighbourhood health evidence that integration is as much cultural as structural.

However, the report also underscores the early and uneven nature of Place-level commissioning practice. With permissive policy frameworks and variable local interpretation, there is a risk that integrated neighbourhood services remain patchy in reach and impact. Strengthening evidence on what works, for whom, and in what contexts will be essential to ensure that neighbourhood health and care contributes to equity rather than reproducing existing disparities.