Challenges and risks for trust boards

While neighbourhood working presents many opportunities, it also brings risks for trusts and complexities that boards should consider as they support the move to this new model.

Interoperability and fragmented data silos

As we have previously covered, successful neighbourhood working depends on data flowing across organisations. A lack of seamless data flow leads to incomplete patient records in the community setting, forcing staff to use slow workarounds (e.g. telephone or paper), which creates inefficiency, increases administrative burden, and risks clinical safety due to delayed or missing information.

Boards should ensure their relevant teams have:

• Mapped key processes and systems that will support neighbourhood working

• Be prepared to invest in extra infrastructure to support the necessary interoperability

Legacy and toxic technology

Many NHS trusts and other healthcare providers still rely on aging, or 'legacy' IT systems and infrastructure that cannot support the demands of a mobile, data-intensive neighbourhood model (e.g. poor Wi-Fi, outdated hardware).

Boards may wish to consider whether: 

• There has been a recent audit to identify whether current infrastructure can support neighbourhood working. 

• There is a plan in place to upgrade and implement necessary infrastructure and hardware, including ensuring latest security controls are in place 

Cyber risk

With an increase in data sharing, mobile working and collaboration with external partners, the risk of cyber attacks increases. Whilst each organisation is responsible for their own cyber security, there is increased risk that they will be impacted by others organisations’ cyber risk profile.

Boards should ensure:

• That cyber risk is considered when discussing neighbourhood working and planning. 

• That their workforce is educated about what they can all do to reduce risk and protect patients and their data. The NHS “Keep IT Confidential Campaign” is a good example of this.

• They consider that the organisation is only as good as the weakest link and the importance of levelling up all system partners.

Skills and capability

Successful neighbourhood working is underpinned by the assumption that staff can confidently use the integrated systems, mobile tools, and remote monitoring platforms

Boards should consider:

• The baseline digital skills across their workforce and look to increase this if needed. The NHS England Digital Academy’s Digital Skills Assessment Tool will help you to baseline skillsets across your workforce.

• Support communities to develop skillsets, using simple  “hooks” that matter to them (e.g. support with booking a GP appointment), rather than generic IT classes.

• Consider training that not only helps front line staff improve digital skills but also provides an understanding of data quality and use.

Digital inclusion

Neighbourhood working aims to reduce health inequalities, but relying solely on digital channels (like the NHS App or remote consultations) risks excluding vulnerable populations.

Boards should consider:

• Working with communities to identify gaps of exclusion. Organisations such as The Good Things Foundation and FutureDotNow work with communities and large organisations to tackle the digital divide.

• Using user centred design techniques to mitigate against the risk of exclusion.

• Where your system partners, including libraries and community centres, can provide local help from trusted organisations. 

Funding models

Trusts may inevitably need to release control on some of what they spend. Whilst the size of investment for neighbourhood working by trusts is generally small compared to total system expenditure, its impact relies on flexibility and local control. Neighbourhood teams need long-term, predictable funding as it enables sustainable partnerships to be built and supports the need to respond to evolving priorities - for example, investing upfront in prevention and relationship-building, which reduces acute service demands over time.​

Boards should consider:

• How resources can be effectively directed towards team-based and community-led care.

• How neighbourhood teams can be given the ability to adapt spending to local priorities over time.  

• Funding digital products and platforms for the long term rather than on a time-limited project basis which creates cliff edges and uncertainty.