Integrated Neighbourhood Working Must Be Blind to Structural Change...

In this article, Andrew Laird and Matt Carter argue that bravery from local leaders will allow progress to be made on integrated neighbourhood working regardless of the structural change going on higher up…

Big structural change is taking place across public services.

Many Integrated Care Boards are clustering (getting bigger) across the country which is causing a huge distraction. All County Council areas are undergoing Local Government Reorganisation (LGR), again causing a huge distraction. Moving up a level, the new (correct in our view) drive for complete Mayoral Strategic Authority coverage across England adds another item to the to-do list for many councils.

This could be a once in a generation chance to align public service boundaries and achieve geographical co-terminosity.

 Of course, that’s not how it’s playing out.

What is actually happening in a lot of places, take North East Lincolnshire or Bath and North East Somerset as examples, is that integration on the NHS/ICB side is headed in one geographical direction and integration to form Mayoral Strategic Authorities is headed in another.

For LGR areas, the changes mean brand new formal partnerships will need to be established between the new councils (all will be “new” even if retaining the old county footprint) and their NHS partners.

This brings real risks, including:

• Instability in local authority leadership and inability to make long term decisions.

• Possible delays in new council formation and uncertainty over roles for those who hold key relationships.

• Confusion around the definition of “Place” and where accountability will sit.

• Threats to emerging Neighbourhood Health models, which may find it harder to engage with council partners as LGR continues.

• New unitaries potentially distancing governance from neighbourhood voices – although there are ways to mitigate this through creative imagining of the roles of Neighbourhood Area Committees– see our article based on the work the MV team did in Norfolk.

• Local authority financial pressures reducing capacity and ability to engage in neighbourhood collaboration activity, as available resource is focused on reorganisation activities.

  
  

In short, there is a danger that all available reform energy is consumed by structural reorganisation rather than improving the lived experience of people and families who rely on the support of public services.

So, do we need to wait for all this change to settle before progressing integrated neighbourhood working?

Absolutely not.

As the old Irish witticism goes, “If I were you, I wouldn’t start from here.”

But this is where we are—and we need to act.

Misalignment of NHS footprints (ICBs, CCGs, PCNs, Trusts) and local authority geographies has always been a barrier to integration. Boundary mismatch is not new.

And yet, neighbourhood working has continued to grow in places where there is zero co-terminosity between NHS and council structures.

That progress has always been driven by leadership, culture, trust and relationships, not organisational charts.

Neighbourhood Working Must Be Structure-Agnostic. A genuine neighbourhood approach must be blind to whatever sits above it. Structures will continue to evolve for months and years to come. The only reliable constant is the strength of relationships between partners.

Place leaders cannot afford to “wait for the dust to settle”.

A brave yet practical approach

We have to assume that structures will never be perfectly aligned—and that real integration comes from behaviours, relationships and shared purpose, not geography.

This means:

• Acting now, rather than waiting for structural clarity. Build and maintain momentum regardless of the chaos above!

• Having clarity of purpose, especially when governance is confused.

• Building on existing strengths, including local assets, high performing support, existing local relationship which will endure beyond any reorganisation or rationalisation.

• Building and repairing trust across partners and focus on lived experience at neighbourhood level.

• Empowering neighbourhoods, even when formal accountability is distant

• Future-proofing through relationships, not organisational redesign. Use relationships—not structures—as the primary mechanism for integration.

Local Government Re-organisation as an Opportunity

While LGR obviously creates distraction and risk, it also presents a genuine opportunity for places prepared to seize it. It can be:

• A chance to reset in areas where NHS/local authority relationships have historically been strained.

• A moment to establish clearer, more accountable Neighbourhood and Place governance.

• An opportunity for New political and executive leadership to be more open to partnership working.

  
  

There are a number of things local leaders can be doing to ensure LGR is a potential net positive for neighbourhood working - rather than just a risk to be managed.

Investing early in maintaining relationships and joint problem-solving - Council leaders should prioritise explaining the LGR progress to NHS partners and any likely impact. Developing shared narratives and shared priorities across organisations for both residents and staff.

Creating interim governance arrangements focused on those shared priorities - the final (final!) governance arrangement may not emerge for some time, so get up and running with arrangements that will do for now.

Protecting existing strengths and good practice - Leaders must not don’t allow LGR to derail good neighbourhood practice in the name of structural re-organisation.

What Now?

Partners cannot simply pause until structural change is complete. The most resilient and impactful systems will be those led through behaviours, relationships and shared purpose, not organisational tidiness.  Places must view this time as an opportunity to refresh and rebalance collaboration between Local Authorities and the NHS.

Radical Place Leadership offers a practical, human-centred way to make progress on integrated neighbourhood working amid constant change.

Please do get in touch if this chimes with you or if you would like to share your own experience – andrew@mutualventures.co.uk.