The NHS ten-year plan is nearly ready. The rhetoric has settled on three shifts: hospital to community, analogue to digital, cure to prevention. At the centre of the community shift sits the Integrated Neighbourhood Team. Twenty-five pilots are underway.
Sir James Mackay, interim CEO of NHSE, recently set out the ambition: more autonomy for local leaders, less hierarchy, faster decisions. Out with over-regulation and endless approvals. In with outcomes, trust, and risk-taking.
The question is whether the hierarchy, the bureaucracy, and the current ways of thinking that got us here will really enable something new. Or whether INTs will become another acronym in a long sequence of structural rearrangements: HAs, SHAs, NHSE, PCTs, CCGs, PCNs, ICBs. None of which changed how care is delivered at the point where staff connect with the patient.
A tale of two allotments
My allotment association is well organised. The land belongs to the borough council, but the council is rarely troubled. The association self-manages. The committee meets monthly. There are inspections, a shop, shared resources, a summer gathering. None of this happened overnight. It took collaborative leadership and a sense of common purpose.
Across the road is another allotment. No committee. No shop. The plot holders turn to the borough council for decisions, permissions, action. Looking up for everything leads to a dump.
Empower and trust local people with the right resources and there is a good chance they will look after themselves, look after each other, and not rely on the state for all the solutions. The opposite fails everyone.
How we organise ourselves is a choice.
Why existing trusts should not run INTs
The Nuffield Trust has documented the decline of district nurses in England. The disinvestment happened because of weak commissioning, tightening budgets, and contract competition. A district nurse, now employed by a large mental health and community trust, lamented the loss of the link to a GP practice, a local patch, a local base. She is lost in a huge organisation where decision-making is "computer says no." Stuck in a rules-based work plan. She used to be able to decide what a family needed. She does not like her work anymore.
The decline is no accident. We now want to get back to something like that model. But the industry journal for the NHS has already suggested that mental health providers or acute trusts might be well placed to deliver INTs. Is it a good idea for organisations that can barely oversee the services they have now to add another new business model, skill, and capability?
Most merged trusts were set up to fail by default: save money, improve information flows, presume economies of scale. The evidence shows that mergers have largely resulted in a loss of focus, reduced efficiencies, and citizens lost in the bureaucracy.
If neighbourhood care is going to prove the theory of relational public services, focusing on citizen needs rather than institutional convenience, we need something new.
INT by design
At STRASYS, the Decision Intelligence engine for healthcare, our approach to system redesign starts with Population Need Segmentation: understanding what the population actually needs before deciding how to organise the response. The SMASH methodology reverses traditional NHS planning by starting from consumer needs and building outward.
Applied to INTs, this means design principles rooted in evidence, not in convenience:
Rooted in localism. Neighbourhoods in Blyth are not the same as those in Bexley. Not just a medical model, but a needs model. Multidisciplinary teams with minimal bureaucracy and lean governance. Autonomy for local decision-making. New outcome measures. Focus on the citizens with frail, deteriorating, long-term conditions, and end-of-life needs. Focus on children and young people, rebuilding through schools and Sure Start centres. Investment in existing and new destinations to meet needs. Not just signposting.
INTs should not be designed, led, or managed by acute, community, or mental health trusts. They are too big, too bureaucratic, and too invested in the status quo. They have a job to do. It is not INTs.
We learned this through our work with Alder Hey Children's NHS Foundation Trust. When the trust moved from maintaining hospital services to improving the life chances of children and young people, it required new thinking, new structures, new governance. The same principle applies to INTs. New models of care require new models of organisation.
Naeem Younis, STRASYS CEO, argues that INTs need a new business model built from consumer needs up: local staff, locally embedded, understanding the citizen, solving problems, making decisions. The social prescriber as part of the multidisciplinary team, no longer confined to a building, not just signposting. The 150-household model, proven internationally, as the unit of neighbourhood care.
Because, as Ronald Reagan observed, the nine most terrifying words in the English language are: "I'm from the government and I'm here to help."
Decision Intelligence for Healthcare Leaders
How we help NHS organisations make better decisions with better data.
Key Definitions
- Population Need Segmentation
- Behavioural segmentation analysis mapping consumer needs, motivations, and access patterns. In INT design, this means understanding what citizens in a specific neighbourhood actually need before deciding how to organise the multidisciplinary response.
- SMASH Methodology
- The proprietary STRASYS approach that reverses traditional NHS planning. Starts with consumer needs and behaviours, then rebuilds workforce, services, organisation, finances, compliance, and policy from the human outward. Applied to INTs, this ensures neighbourhood care is designed around need rather than institutional convenience.
- Decision Intelligence
- The discipline of converting complex healthcare data into structured, actionable decisions for NHS leaders. STRASYS coined and owns this category in UK healthcare, combining analytics, behavioural science, and systems thinking.
- Integrated Neighbourhood Teams (INTs)
- A proposed NHS model of community-based multidisciplinary care aimed at shifting demand away from the acute sector. Twenty-five pilots are underway. STRASYS's position is that INTs must be designed from population need upward with new governance models, not retrofitted into existing trust structures.
Frequently Asked Questions
INTs are a proposed NHS model for shifting healthcare from hospitals to communities through locally embedded multidisciplinary teams. Twenty-five pilots are underway as part of the ten-year plan. The ambition is to address frailty, long-term conditions, end-of-life needs, and children's health closer to where people live rather than through hospital admissions.
Acute, community, and mental health trusts are too large, too bureaucratic, and too invested in the status quo. Most merged trusts have produced loss of focus and reduced efficiencies rather than the intended economies of scale. INTs require minimal bureaucracy, lean governance, and rapid local decision-making. Embedding them within existing institutional structures will reproduce the very problems they are designed to solve.
STRASYS advocates designing INTs from population need upward using Population Need Segmentation and the SMASH methodology. Design principles include: rooted in localism, needs-based rather than medical-model, multidisciplinary with lean governance, autonomous local decision-making, new outcome measures, and focus on citizens with frailty, deteriorating conditions, end-of-life needs, and children and young people.
International models, including Brazil's community health worker programme, demonstrate that teams serving approximately 150 households can deliver measurable improvements in health outcomes through relationship-based care. Dunbar's Number research in evolutionary psychology supports 150 as the upper limit for meaningful human relationships within a community unit.
Population Need Segmentation provides the evidence base for what a specific neighbourhood needs. The SMASH methodology ensures the care model is designed from consumer needs outward rather than from institutional structures downward. The Alder Hey case study demonstrates how starting from population need rather than institutional capability produces fundamentally different service models with measurable outcomes.
This article is adapted from the Friday Fish and Chip Paper, Dr Nadeem Moghal's weekly newsletter on LinkedIn.
Dr Nadeem Moghal
Chief Medical and Innovation Officer