The Ambition for IHOs and Neighbourhoods

New planning guidance is reshaping ambitions for integrated health organisations (IHOs) and neighbourhood models within the NHS. The 2026–29 planning framework marks a clear adjustment from the aspirational tone of the 10-Year Health Plan.

The guidance confirms that an “integrated health organisation” will not be a new statutory body but a contractual arrangement held by existing organisations or partnerships between them. Further neighbourhood guidance is expected to clarify that IHOs will often operate alongside both “multi-neighbourhood providers” and “single neighbourhood providers”, moving away from rigid structural choices.

Instead of requiring areas to select between acute-led IHOs or primary care-led models (MNPs), the approach promotes overlap and interdependence. Areas such as Northumbria and West Hertfordshire, which are moving towards IHO models, suggest these will not take the form of foundation trusts or new statutory bodies. Existing trusts are likely to adopt a more limited “host” role within broader partnerships.

Challenges of Partnership and Implementation

This direction reintroduces the complexity of multi-organisation arrangements that characterised earlier integration efforts. The notion of establishing IHOs through simple legislative changes has been set aside. National and local leaders must now work through the contractual, relational, and legal challenges, including competition rules, that have historically hindered integrated care.

The difficulties are similar to those encountered in previous “new care model” and “outcome-based contract” initiatives from a decade ago. Those efforts achieved mixed results, often proving slow and contentious. Although some areas, such as Surrey, have reported success, most have struggled to maintain momentum amid political and operational challenges. Sustained political commitment will be essential if this latest agenda is to progress.

If that commitment exists, the contractual model could allow IHOs to develop more rapidly. Without waiting for new legislation or central approval processes, commissioners could have greater flexibility to design and implement local models according to need. This approach may also continue even if the proposed health bill is delayed or withdrawn.

IHO contracts are expected to evolve from the “urgent and emergency care payment model” due for wider use in 2026–27. NHS England is considering ways to link this framework to outcome incentives, preventive care, and management of frailty among older populations. However, moving from this base to a whole-population budget would represent a significant shift. The current guidance provides no timescale for issuing model contracts or funding mechanisms and sets no national targets for expansion by 2029.

At the same time, the guidance gives priority to short-term clinical objectives for neighbourhood health. The immediate aims include improving access to general practice, reducing non-elective admissions, and lowering outpatient activity. Some observers believe that this short-term focus could cause neighbourhood development to fall further down the agenda.

Leadership and the Future of NHS Integration

There are also concerns within government about the Department of Health and Social Care (DHSC) being dominated by NHS perspectives. Critics argue that this can reinforce traditional hospital-centred thinking, often associated with demands for additional funding. To counter this, Health Secretary Wes Streeting has appointed Matt Hood, an education specialist known for founding an online teaching platform during the pandemic, as a delivery adviser. His appointment introduces experience from outside health and social care, although his influence may be limited given his lack of sector background and the seniority of existing NHS leaders.

Meanwhile, Tom Riordan, the former Leeds Council chief executive, has resigned from his senior role in the DHSC. His departure removes a figure who had provided balance against hospital-focused policymaking. Riordan’s collaborative leadership style and cross-sector experience were viewed as valuable assets in the drive for more integrated and efficient services. Sir John Oldham, another advocate for broader approaches to neighbourhood health, also left the department last month.

Several senior officials with wider public service experience remain, including Sally Warren, recently confirmed as director general for adult social care. Even so, the department continues to face challenges in aligning health and social care ambitions. With central control of NHS priorities reasserted and political focus on service targets, it remains uncertain whether this combination of expertise and direction will achieve the integrated system envisaged in national policy.