The NHS England initiative is designed to reshape the structure and priorities of both health and social care in England. The programme aspires to decentralise services, enhance integration across sectors, and improve outcomes and experiences by focusing on localised, community-based care delivered through neighbourhood teams that bring services closer to where people live.
Why This Matters to Xytal
At Xytal, supporting meaningful change in healthcare is core to what we do. This initiative resonates with our experience across multiple areas:
- Care closer to home – aligning with our extensive work in primary care.
- Integrated care across services – reflecting our expertise in cross-organisational working, including the development and support of neighbourhood teams.
- Proactive and preventative approaches – drawing on our delivery of the “left shift”.
- Population segmentation and targeting of high-need groups – linking to our strengths in digital transformation, integration, and utilisation.
Our experience of delivering national programmes also underlines the importance of high-quality evaluation, often led by our university-based advisers, to ensure adoption, spread, and evolution.
The Benefits for People and the System
The programme promises shared benefits between the service users (lets’s call them people) and the wider system. For people, improvements include better access and experience, particularly in tackling health inequalities. For the system, the emphasis on community-based care supports the sustainability of health and social care—ensuring resources stretch further in a world where every service is delivered within financial constraints.
The Realities of Delivering Change
Xytal has always focused on the practicalities of making change happen. The initial priority areas identified highlight this challenge:
- Adults with frailty and dementia
- Children with complex physical and mental health needs
- Frequent users of emergency services
These groups not only represent significant cost base but also often, more importantly fail to get the outcomes they seek in a purely medical, pathology-orientated system. To make a difference, system-level change is required.
Building the Capabilities to Deliver Change
For transformation to succeed, the system must develop new capabilities and competencies. These include:
Creating a Shared Vision
Every change management programme begins with a shared view of what good looks like. Achieving this requires collaboration across health, social care, voluntary sectors, and neighbourhood teams that serve as the foundation of local integration. Strategic leadership and skilled facilitation are vital in shaping aspirations that unite organisations with little history of working together. This stage maps closely to the Define phase of our DMAIS methodology:
- Define
- Measure
- Analyse
- Improve
- Sustain
Delivering Systematic Change
Evidence shows that teams following systematic approaches achieve greater success than those without structure. Our methodology, based on the Model for Improvement, is designed for complex, human systems—recognising the limitations of more linear approaches when applied to system-wide change.
Building Trust and Compassionate Leadership
Even with direction set, delivery can fail if organisations lack trust, both between individuals and between organisations. Transparency, honesty, and psychological safety are essential for progress. This nurtures both the services themselves and the multi-organisational teams delivering them. We call this compassionate leadership, combined with systems thinking, the ability to look beyond one’s host organisation. At times, conflict management skills are also required to maintain alignment.
Turning Vision into Action
Pragmatic managerial skills are also crucial. This includes:
- Effective data utilisation across fragmented systems
- Digital integration to ensure technology serves clinicians and patients
- Project management to ensure delivery
- Governance arrangements that safeguard public resources
These skills transform aspirations into action.
The Scale and the Opportunity
While the ambition of neighbourhood integration is vast, the organisational competencies needed are not new. They mirror those required in other large-scale change programmes we have successfully supported. At Xytal, our role is to provide the leadership, tools, and practical expertise that help turn vision into reality.
