Shaping the system: neighbourhood health

Across the UK, physiotherapy services are already seeing changes linked to the shift to delivery care closer to home – from redesigned outpatient pathways to new neighbourhood teams and integrated services.  

For many members, that means questions about where services will be delivered, how teams will work, what resources will be available and how decisions are being made. 

The CSP’s approach is clear: these changes should not happen to physiotherapists. Members should be actively involved in shaping them. 

That is why the society is developing new organising and support resources to help members respond collectively and constructively as neighbourhood health develops locally. 

One of the most immediate practical issues is the relocation of outpatient physiotherapy services from hospital settings into community spaces. 

The CSP has developed an outpatient’s framework, currently being shared with member representatives ahead of wider rollout, to help ensure that when these proposals emerge the right questions are being asked early – and by organised physiotherapy teams. 

The framework focuses on issues members consistently raise as critical to safe, effective services and sustainable working lives: whether proposed spaces are clinically appropriate; whether they are accessible for patients and staff; whether equipment and rehab facilities are adequate; whether staff terms and conditions are protected; and whether physiotherapy teams and CSP organisers have been meaningfully consulted and the plans have been robustly risk assessed before decisions are made. 

The CSP’s position is that done well, moving services into communities can improve access, support prevention and bring care closer to people’s lives. But members know that redesign without proper planning can also create risks – for patients, staff and services alike.  

The modernising outpatient’s framework is intended to help physiotherapy teams engage early, collectively and from a position of strength – ensuring rehabilitation expertise shapes neighbourhood models rather than responding after decisions have already been taken. 

That organising work is supported by CSP teams across the UK. Local CSP teams bring together professional advisers, senior negotiating officers, organisers, campaigns and regional engagement officers, and – in the devolved nations – public affairs and policy staff. 

Together, they support members with workplace issues, service redesign, campaigning and local influencing activity. 

This has the potential to be transformative for patient care. A national rehabilitation framework could help ensure people get the support they need to recover, regain independence and live well wherever they are in the system.

For members, that can mean support to organise around proposed service changes, guidance on how to influence local systems and commissioners, help to build campaigns locally, or support connecting with other physiotherapists facing similar challenges in their area and you can contact them on email enquiries@csp.org.uk.

The CSP’s regional networks and country boards also provide member-led spaces for physiotherapists to connect, share intelligence and organise around the issues affecting their services and communities. 

Practical help and support 

Alongside work on the outpatient’s framework, the CSP is developing practical tools to help members plan and deliver neighbourhood services. 

A forthcoming neighbourhood health hub will bring together evidence, service examples, population health resources and practical guidance to support members engaging in local redesign conversations. 

Nationally, the CSP is also working to shape the wider direction of neighbourhood health policy and reform. 

Central to that work is the forthcoming Five Principles for Neighbourhood Health report, which will be published on the CSP website this month. 

The report argues that neighbourhood health will only deliver on prevention, recovery and independence if rehabilitation is designed into systems from the outset – not treated as an optional add-on once other decisions have already been made. 

Using case studies from physiotherapy-led services across the UK, the report sets out how rehabilitation supports prevention and self-management, recovery after illness or crisis, reduced pressure on urgent and emergency care, and improved long-term independence and quality of life.

It also makes the case for physiotherapy and allied health professional leadership to be built into neighbourhood models from the start. 

National influencing 

The CSP will take those arguments directly into national policy and commissioning conversations. 

The report will be showcased at NHS ConfedExpo, one of the largest gatherings of NHS leaders, commissioners and system partners in England, where CSP assistant director Sara Hazzard will join a panel discussion alongside national health leaders on the future of neighbourhood health. 

An updated edition will also be presented at the King’s Fund annual conference later this year, helping ensure rehabilitation and physiotherapy are part of high-level conversations about how neighbourhood models develop nationally. 

The CSP is also supporting parliamentary organising and advocacy through the new all-party parliamentary group (APPG) for allied health professionals, chaired by practising physiotherapist and Labour MP Sonia Kumar, with the CSP acting as secretariat. 

The APPG creates another route for physiotherapy voices and member experiences to reach MPs and peers, strengthening the case that rehabilitation is essential infrastructure for prevention, recovery and NHS sustainability. 

That profile is already beginning to grow. Earlier this year, Sonia Kumar secured the first House of Commons debate focused on allied health professionals, with MPs highlighting physiotherapy’s contribution to prevention, rehab and recovery using evidence and examples drawn from CSP briefings and member experiences. 

Campaigning with partners 

Behind all of this sits a wider ambition: securing stronger national standards and expectations for rehabilitation services. 

The CSP and its partners in the Community Rehabilitation Alliance are continuing to push for a national Modern Service Framework for rehabilitation covering both community and inpatient settings. 

The aim is to address longstanding variation in access to rehabilitation services, which continues to drive health inequalities and leave too many people without the support they need to recover and live independently. 

Sara Hazzard believes the stakes are high. 

This has the potential to be transformative for patient care. A national rehabilitation framework could help ensure people get the support they need to recover, regain independence and live well wherever they are in the system. 

‘For too long rehab has been treated as optional when it is essential to delivering safe, effective healthcare. The absence of any clear national standards has played a part in the unacceptable variation in access, with too many patients missing out.’ 

Ultimately, the CSP sees organising locally and influencing nationally as part of the same picture. 

When physiotherapists come together locally to shape service redesign, challenge poor proposals or make the case for rehabilitation in neighbourhood models, they are not acting alone. They are supported by national evidence, policy work, organising structures and campaigning already underway across the profession. 

And the argument the CSP is making – locally, nationally and politically – is straightforward: physiotherapy is not peripheral to neighbourhood health. It is one of the services that will determine whether neighbourhood health succeeds.