The wool, the vicar and the bridge

(and why you should consider applying for the National Neighbourhood Health Implementation Programme)

A few weeks ago, I was in Wadebridge, Cornwall for a county event celebrating, learning, developing and planning integrated neighbourhood teams. The room was buzzing as the attendees from physical and mental health services, local authority and the voluntary sector connected and reconnected. The sense of excitement was founded on a willingness to share what had worked and what hadn’t, listening to those who had come a little further and a keenness from those who were eager to catch up.

As I reflected on the day, I remembered a sign I had come across in Wadebridge the evening before. Wadebridge was originally just Wade until the bridge was built in 1468. Over 500 years later I walked across it. The sign next to the bridge caught my eye, being one of those annoying people that reads that sort of thing. I wondered why the bridge was built? Well, the vicar of Egloshayle, Reverend Thomas Lovibond (what a great name) was concerned about the number of deaths that occurred in Wade as the locals crossed the dangerous fording point on the Camel River. He set about building a bridge and legend has it that the bridge was built on sacks of wool, presumably as this was in plentiful local supply.

A bridge as old as this has witnessed a few events. It featured in the civil war, being taken in 1646 by Cromwell, it has been widened twice in 1853 and 1963 and was refurbished in 1994 at which point it gained the sign that piqued my interest.

What has that got to do with moving care closer to home and the development of neighbourhood health? There was a local health and wellbeing problem, folk were dying and people were stirred into action. The lead for this came from, I guess we would call it today, the voluntary, community, faith and social enterprise sector (VCFSE). They used the assets they had (wool, with perhaps a little stone) and built something that still exists today. It had wider effects over and above reducing the number of deaths. It will have had economic benefits from the reduction in lives lost but also reduced travel time, increased trade and the societal benefit from connecting the communities on either side of the river. It was of strategic importance in the civil war.

Neighbourhood health is front and centre of the 10-year plan. The principles that will make it a success are the same as in the 1400’s. Understanding the local health and health wellbeing problems, harnessing the assets of the community and creating something that will last and that has benefits beyond the narrow view of just health. It is interesting to note what didn’t happen: the river wasn’t diverted, or signs put up, or life jackets provided (apparently, they did try a ferry). The change was significant. Neighbourhood health isn’t a tinkering around the edge with the river of a hospital-based system, it needs to be a wholescale change.

To support the development of neighbourhood health, NHSE have launched an implementation programme. Whilst the closing date is soon (08/08/2025), there is encouragement to apply even if not every applicant will be successful. The national team will consider applications from more than one place per system and ultimately are looking to support all places in developing neighbourhood care. The process itself can help as a focus for local conversations; history tells us that the those who innovate can shape outcomes both locally and nationally. The drivers behind neighbourhood aren’t going to go away.

Primary care and in particular general practice, are being asked to play a significant role, with an encouragement to lead neighbourhood providers, and 2 new contracts in the offing for populations of 50 and 250 thousand. The detail behind these is yet to be revealed, however innovative primary care has an opportunity to shape what these may contain. Showing interest in national programmes helps to make the case for focus and funding.

Finally, back to the bridge, just as neighbourhood health and wellbeing will change over time, so has the bridge. It was widened twice and refurbished once. I am not sure we have any neighbourhoods who can say they just need a refurb, however there is a spectrum of those who perhaps need to consider what the local health and wellbeing needs are, to those putting down the first wool sacks, to those continuing to build, to those who might need to consider widening it and making sure all partners are involved. Whatever stage people are at, we can’t simply stand looking at the river thinking we can wade across, when there are bridges to be built.

For more information on Integrated Neighbourhood Teams click here