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Facilitation

Neighbourhood health • ICB facilitation • System change • Outcomes framework

Helping system partners build a shared Logic for Change for Neighbourhood Health

A London-based ICB needed help bringing together a wide range of stakeholders to design a logic model and outcomes framework for Neighbourhood Health.

The challenge

A London-based ICB needed to develop a shared logic for change and outcomes framework for Neighbourhood Health across a large and complex health and care system.

The ambition was significant: to shift towards more preventative, proactive and community-based support; improve population outcomes; reduce avoidable demand; and enable greater shared accountability across the system.

But 'Neighbourhood Health' meant different things to different people. The work needed to connect the priorities of NHS organisations, commissioners, local authorities, neighbourhood teams, community and voluntary-sector partners, while the national policy context and local organisational landscape were still evolving.

The challenge was not simply to draw a logic model. It was to develop enough shared clarity about:

  • what Neighbourhood Health was seeking to change;

  • how neighbourhood working was expected to produce better outcomes;

  • what needed to change for people, communities and the wider system;

  • which enabling conditions had to be in place;

  • how value and progress could be understood and measured;

  • and what remained uncertain or needed to be tested through implementation.


The framework also needed to avoid presenting Neighbourhood Health as an NHS service-delivery model. It had to recognise that outcomes depend on community capacity, prevention, relationships, commissioning, data, workforce, local infrastructure and the way different organisations work together.

What we did

The Future Works worked alongside Hannah Woods of Out of the Woods Ltd and Linda Jackson of The Loom to lead a three-phase process of insight generation, co-development and testing.

1. Understanding the opportunity
We conducted stakeholder interviews and synthesised qualitative evidence, existing strategies, national guidance and emerging local thinking.

This helped us identify where there was already alignment, where different interpretations of Neighbourhood Health existed, and which assumptions or tensions needed to be explored further.

2. Co-developing the system logic
Through facilitated workshops and working sessions with colleagues across commissioning, public health, neighbourhoods, strategy and data, we developed:

  • a shared definition of Neighbourhood Health;

  • ten design principles to guide its development;

  • a system-wide Meta Logic for Change, with outcomes spanning People, Communities and the System;

  • a clearer account of the enabling conditions needed for change;

  • and a framework for thinking about personal, technical and allocative value.


This moved the work beyond a conventional health-service logic model. It made visible the contribution of community participation, stronger neighbourhood relationships, coordinated working, aligned commissioning and shared accountability - not only clinical activity or service utilisation.

3. Testing how the logic could be applied
We then tested the Meta Logic through a more detailed Transformation Logic for Adults with Complexity.

This provided a first worked application of the system framework, exploring how coordinated neighbourhood working could support earlier identification, more proactive and personalised care, reduced reliance on crisis services, and improved outcomes and experiences for people with complex needs.

Testing sessions explored the implications for commissioning, delivery, measurement and learning. We developed an initial measurement structure, including potential indicators relating to partnership effectiveness, reach and equity, coordinated care, pathway duplication, non-elective admissions and people’s confidence in managing their health.

We also distinguished between measures needed at ICB level for strategic oversight and accountability, and a broader neighbourhood-level 'basket' that could support local learning and adaptation.

Engagement during this phase drew most heavily on ICB, NHS and integrator stakeholders, with contextual input from local authority, community and voluntary-sector perspectives. The final recommendations therefore made clear that wider testing with residents, carers, communities, local authorities and VCSE partners would be an important next step.

What changed

The project gave the ICB a more coherent and practical account of how Neighbourhood Health was expected to create change.

Rather than a collection of broad ambitions, the system now had:

  • a shared narrative connecting neighbourhood activity to outcomes;

  • a Meta Logic that made People, Community and System outcomes equally visible;

  • ten principles against which emerging neighbourhood models could be tested;

  • an initial cohort-level Transformation Logic showing how the framework could be applied in practice;

  • a clearer distinction between strategic outcomes, commissioned outcomes and local measures;

  • and explicit recommendations about the commissioning, data, workforce, community and relational conditions needed for success.


The work also surfaced what could not yet be treated as settled. In particular, it made clear that the assumed relationships between proactive support, equity, outcomes, demand and value would need to be tested through implementation rather than presented as guaranteed.

This gave the ICB a stronger foundation for strategic commissioning, ongoing system conversations, practical testing and shared learning - without creating false certainty in a still-emerging area of policy and practice.

Our 'special sauce' on this project

This was not simply a technical logic-model design exercise. Logic models can make change look neat and linear. Systems are neither!

Our value came from combining three forms of expertise that are rarely brought together:

1. System leadership and system change expertise. We understood that Neighbourhood Health would not succeed through service redesign alone. Political priorities, organisational boundaries, commissioning arrangements, legacy processes, power, relationships and trust all shape what is possible. This allowed us to identify the conditions and barriers behind the formal model, rather than treating them as peripheral implementation issues.

2. Outcomes, evaluation and impact expertise. We brought technical rigour to the development of causal logic, outcomes, indicators and value. We helped distinguish between what the system hoped would happen, what it could reasonably influence, what needed to be measured and what still needed to be tested.

3. Facilitation and system-convening expertise. We created structured spaces in which people with different roles, language and perspectives could contribute meaningfully. We synthesised complexity without flattening it, surfaced areas of disagreement and translated abstract ambition into a framework that commissioners, strategists and delivery partners could use.

An internal team inevitably works from within the system’s existing structures, relationships and accountabilities. Our independence allowed us to ask questions that can be harder to hold internally:
 

  • Whose definition of value is shaping this framework?

  • Which outcomes matter beyond the NHS?

  • What would commissioning need to do differently?

  • Which enabling conditions could be undermined by existing processes?

  • Where are we describing a genuine causal relationship, and where are we making an assumption that needs testing?


Another partner might have produced a technically tidy logic model. Our contribution was to ensure that the logic reflected the much messier reality of system change - and was robust enough to guide action without pretending that complexity had disappeared.

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