Government Launches Neighbourhood Health Framework With Care Home Admissions Reduction Target at Its Core
The government has unveiled its long-awaited Neighbourhood Health Framework — a sweeping blueprint designed to shift the centre of gravity in English healthcare from hospitals to local communities. For care home providers, the document carries significant implications: it names residential and nursing care homes as a focus for service redesign, and sets a national objective to reduce admissions to them.
Published jointly by the Department of Health and Social Care and NHS England, the framework sets out how a new “neighbourhood health service” will be constructed across England over the coming years, drawing together GPs, community health teams, social care, and voluntary sector bodies under a co-ordinated local model.
Among the most significant passages for the care sector, the framework states that the NHS will work to reduce “avoidable care home admissions” as part of its drive to decrease pressure on more acute services. It also lists care home residents as one of the high-priority cohorts for whom integrated neighbourhood teams (INTs) will be established as an immediate national priority.
The document further identifies people with mid to severe frailty, care home residents, and housebound patients as the groups who will receive the most intensive community support under the new model. A concrete NHS target has been set to reduce non-elective hospital admissions and bed days of one day or more by 10 per cent for this group by March 2029, measured against a 2025/26 baseline.
The framework also includes adult social care outcome measures that integrated care boards (ICBs) and local authorities are expected to track, explicitly referencing: “the number of adults whose long-term support needs are met by admission to residential and nursing care homes” — broken down by age — per 100,000 population.
Minister of State for Care Stephen Kinnock MP, who contributed the framework’s foreword, described neighbourhood health as a “joint endeavour between the NHS and local authorities, alongside wider partners”. He acknowledged that despite consistent aspiration for a community-centred model over the past fifteen years, the NHS has drifted further towards hospital-based care, with investment following suit.
The framework describes a five-point hierarchy of where care should be provided: as locally as possible; digitally by default; in a patient’s home where feasible; in a Neighbourhood Health Centre (NHC) when needed; and in hospital only as a last resort.
The government has committed to building or upgrading 250 Neighbourhood Health Centres across England, with 120 to be delivered by 2030. These centres will bring together GP services alongside community health, local authority, and voluntary sector provision — described as the places where people will go for “most health needs in every community”.
Central to the delivery model are Integrated Neighbourhood Teams (INTs) — multidisciplinary groups bringing together different health and care professionals to work alongside one another in defined local populations. The NHS has deliberately avoided prescribing what an INT must look like nationally, acknowledging that models will vary. Significantly, the document notes that “some INTs may benefit from the inclusion of care workers”.
INTs will initially be expected to focus on four cohorts:
- People with frailty and those requiring end of life care (described as accounting for 3–5 per cent of the population but over 25 per cent of non-elective admissions and 50 per cent of bed days)
- Patients with multiple long-term conditions including cardiovascular disease, diabetes, COPD and dementia
- Children and young people
- People living with cancer
The framework also sets a goal that by 2027, 95 per cent of people with complex needs will have an agreed care plan — a commitment that could have direct implications for how care homes and community teams co-ordinate around individual residents.
The framework places particular emphasis on expanding urgent community response (UCR) services — specifically to prevent avoidable hospital attendances among people experiencing frailty or falls. It also commits to increasing virtual ward capacity and intermediate care, with explicit reference to step-up and step-down services as a means of keeping people out of hospital and supporting timely discharge.
The government is also targeting a reduction in category 3 and category 4 ambulance conveyances for high-priority cohorts — again explicitly naming care home residents among those groups — by March 2029.
The framework is primarily directed at ICBs and NHS providers, with local authorities as secondary partners. Care homes are not addressed directly as stakeholders. However, the trajectory it sets — explicitly measuring admissions to residential and nursing care as an outcome to be reduced — signals a direction of travel that the sector will need to engage with closely.
For providers, the immediate questions concern how INTs will interface with care homes, whether care workers will be incorporated into those teams, and how the push for proactive community-based support will affect referral patterns and occupancy in the medium term. The framework anticipates that neighbourhood health will reduce pressure on care homes by supporting more people to remain in their own homes — but offers limited operational detail on what the transition will look like for existing residents and established care home services.
Reassuringly, the document does acknowledge the social care workforce as part of the neighbourhood health picture, and it explicitly frames ICBs as needing to work closely with local authorities as commissioners of social care. Adult social care priorities — including quality of life and satisfaction measures — are integrated into the framework’s local outcome metrics.
The framework sets out a two-stage implementation. In Stage 1 (2026/27), ICBs must agree immediate plans to reduce non-elective admissions, establish neighbourhood geographies, set up INTs for high-priority cohorts, and confirm data-sharing arrangements. In Stage 2 (from April 2027), ICBs will be expected to produce full neighbourhood health plans, developed jointly with Health and Wellbeing Boards, which will then be incorporated into five-year strategic commissioning plans.
The National Neighbourhood Health Implementation Programme will support local systems through the change. NHS England will also publish further guidance on population health delivery models in coming months, alongside a series of “modern service frameworks” covering frailty, dementia, cardiovascular disease, severe mental illness, end of life care, and children and young people — areas of direct relevance to nursing and residential care.
