Morecambe Bay National Neighbourhood Health Implementation Programme

Morecambe Bay National Neighbourhood Health Implementation Programme

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The National Neighbourhood Health Implementation Programme (NNHIP) aims to support the transformation of the health and care system by developing neighbourhood-based health services. This involves redesigning and integrating current health and care services to shift focus from hospital settings to community-based care, often referred to as a 'left shift' approach. As a national initiative, NNHIP has established local programmes to pilot new approaches, facilitate shared learning, and recommend potential future developments over an 18-month period. Since NNHIP does not provide additional funding for neighbourhood development, the work will primarily focus on optimising existing efforts and expanding successful initiatives.

Morecambe Bay was successfully selected as part of NNHIP’s Wave 1 activities to trial certain 'left shift' strategies. For our area, there are nine neighbourhoods aligned with nine Primary Care Networks (PCNs) and Integrated Care Communities (ICCs).

The target population for this initiative includes individuals with multiple comorbidities and complex needs, specifically those who:

• Have two or more or three or more long-term conditions, and

• Are current high-intensity users of health and/or social care services, or

• Show an increasing risk of escalating healthcare needs.

The scope of our work is divided into three key areas:

1. Operational: Developing sustainable, tailored approaches to service delivery within our area.

2. Cultural: Implementing organisational changes to support the 'left shift' of care into community settings.

3. Strategic: Developing a collectively agreed-upon future model for neighbourhood health services.

The latest workshop, held on 13 January, focused on hospital discharge processes and multidisciplinary teams (MDTs).

Hospital discharge aims to be a comprehensive and supportive process for residents and clinicians. To enhance the discharge experience, we aim to improve care planning quality, ensure that it is current and relevant, and raise awareness of accessible health and wellbeing services and models of care for hospital teams. Most of these improvements will be led and coordinated by the University Hospitals of Morecambe Bay NHS Foundation Trust.

Regarding MDTs in neighbourhoods, three pilot projects are currently underway. These pilots collaborate with PCNs and ICC teams, each selected for their unique characteristics:

• Kendal: A market town with a significant frailty population.

• Bay: A large urban area within a single county, with an established network.

• Western Dales and Carnforth: Two ICCs spanning across county boundaries.

The initial step involves developing a system to identify patients who do not typically get referred to MDTs but are at a rising risk of requiring increased clinical support, and who are not currently engaged with other intervention pathways such as Local Enhanced Services. The deadline for establishing this patient identification process is 31 March 2026.

Starting from April 2026, the identified patients will be assessed, and where appropriate, included in standard MDT review. An evaluation of the impact on patient outcomes will follow to assess the effectiveness of these interventions, understand what approaches are successful, identify areas for improvement, and determine engagement levels among the target population.