Ealing Council is implementing a new Neighbourhood Health Model aimed at tackling health inequalities and providing more integrated, preventative care for residents. The initiative, discussed at a recent Health and Wellbeing Board meeting, focuses on delivering services closer to home and addressing the specific needs of communities within eight designated neighbourhoods across the borough.
These neighbourhoods don't quite align with towns, but very close to,
according to Lizzie Bogle, Director of Transformation for West London NHS Trust and Acting Managing Director for Ealing BBP. This localised approach is designed to target areas with the highest deprivation, lowest life expectancy, and highest non-elective bed utilisation, as indicated by data presented to the board. 
The Better Care Fund (BCF) will play a significant role, with approximately £60 million allocated for 2026/27. This funding will support preventative services, the voluntary sector, and neighbourhood health initiatives, with a focus on reducing hospital admissions and enabling residents to live independently for longer. Key investments include residential care, intermediate care, and the Disabled Facilities Grant.
The Ealing Borough Based Partnership (BBP) is central to this strategy. The BBP's work is designed to address challenges such as health inequalities, increasing demand for mental health and children's services, and variations in health outcomes across different neighbourhoods. For 2026/27, planned deliverables include the refurbishment of Carmelita House as a children's therapy centre and the opening of a Neighbourhood Health Centre at Jubilee Gardens. Both projects are slated for completion within the 2026/27 timeframe, with funding secured for the Jubilee Gardens upgrade.
Councillor Paul Driscoll, Chair of the Health and Wellbeing Board, highlighted the importance of this neighbourhood-based approach. The critical change really is this multidisciplinary approach,
he stated. Actually, if you are a frail elderly person within Greenwell where the frailty MDT is currently successfully running, the team is talking about you and they're talking about the fact that we're actually going to visit you tomorrow. And so you're not repeating your history, your services multiple times.
Lizzie Bogle, Director of Transformation for West London NHS Trust and Acting Managing Director for Ealing BBP, explained the vision: We have devised neighbourhoods within Ealing which don't quite align with towns, but very close to. So we've got eight neighbourhoods sitting within Ealing and each of those has got a kind of multidisciplinary, local authority, voluntary sector. NHS team that are working locally, both on projects with local people to deliver prevention activities, but also now trying to deliver health at a local level to make sure that we're targeting and supporting those patients as close to home as possible, or within their homes where we can.
The BCF plan, which has been approved by the national team, outlines how Ealing will continue to invest in preventative services and integrated care. Avtar Maan, Head of Integrated Commissioning, noted that the BCF is a key mechanism for delivering integrated and preventative care across Ealing and continues to provide a vital platform deliver system wide person-focussed health and care.
The plan also mentions strengthening the role of the voluntary sector through a joint grants program. Attendees at the meeting stressed the importance of adequately resourcing the voluntary sector, acknowledging their vital role in prevention and independence, especially given current economic pressures.
Success will be measured by what matters most to residents: improved health and wellbeing, reduced inequalities, greater independence, stronger community resilience, and reduced reliance on hospital-based care. For 2026/27, specific improvement goals will be set against three headline metrics: non-elective admissions to hospital for people aged 65 and over per 100,000 population, discharge delays (proportion of people discharged by their Discharge Ready Date, average length of discharge delay, and average number of days from DRD to discharge for those not discharged on time), and long-term admissions to residential and nursing care homes for people aged 65 and over per 100,000 population.
The initiative aims to shift resources and activity from hospitals to neighbourhood settings, fostering greater independence and improved health outcomes for all residents. The Assertive Outreach Team for mental health is being developed to reach out to our most vulnerable mental health patients and those that are struggling to access and engage with support from a mental health perspective,
described as a community based team to identify and work with those in the population who need to work more with community services.
The 24/7 Neighbourhood Mental Health Centre is planned with an Open access, no wrong door walk-in, call or referral, with no threshold and no discharge for missed appointments.
Further details on the structure and referral pathways for the multidisciplinary teams operating within each neighbourhood are still being developed, but the aim is to create teams that are known to all the practices, it's known to local authority colleagues and we can work within those neighbourhoods to be able to deliver prevention and also care at that neighbourhood level.
The design principles for the 24/7 Neighbourhood Mental Health Centre also include being Co-produced and equity-led designed with people with lived experience and VCSE/faith partners, reaching the borough's most underserved communities.
More information on the Better Care Fund plan can be found in the Public reports pack for the Health and Wellbeing Board.
Minutes of the Health and Wellbeing Board meeting and the Agenda frontsheet are also available.