Neighbourhood Health Services: Governing through relationships and boundary-spanning

The NHS Medium Term Planning Framework (MTPF) marks a milestone moment in this government's system reform - a shift from short-term transactional planning, to multi-year, place-based planning and co-ordination at a neighbourhood level. It asks neighbourhoods to become the organising unit for joined up care - where primary care, social care, local government, NHS Trusts, VCSE organisations (and many others) align around local population need.

But this is not integration by structure. It cannot be commanded. It requires integration by relationship: the ability to work collaboratively across organisational, professional and jurisdictional boundaries in the pursuit of creating public value - through trust, negotiation and shared learning.

As with all my articles, I'll be looking at the management literature on boundary-spanning through the eyes of a medical doctor and Chartered Manager, to help you engage critically with theories, models and frameworks for managing and leading. I will examine:

Why neighbourhood health services depend on boundary-spanning

Neighbourhood partnerships operative in an inherently complex and messy environment. They bring together statutory, voluntary and community actors, each with distinct missions, sources of legitimacy, incentives and accountability regimes.

The connective work that binds these elements together is boundary-spanning:

• building trust and shared purpose across organisational divides
• translating between different professional and institutional languages
• negotiating resources, legitimacy and expectations
• maintaining joint momentum amid conflicting and competing pressures.

Research by Satheesh et al. (2002) shows boundary-spanning activities by public service managers directly enhance collaboration quality, and that higher quality collaboration results in improved performance. Effective partnerships, therefore, are those that deliberately and purposefully cultivate relational and mediating functions, that than assuming they will occur organically.

Collaborative Advantage and New Public Governance

Huxham and Vangen's Theory of Collaborative Advantage explains that the success of partnerships create value only when structural enablers (such as governance, leadership and resources) and social enablers (such as trust, mutual understanding and shared purpose) work together. Governance frameworks and shared budgets matter - but so do trust, mutual understanding and reciprocity...

Ferlie and Ongaro's work on New Public Governance reframes public leadership as a matter of network stewardship. Positive outcomes emerge not from commands or control, but the quality of interactions between actors. In this view, relational governance is not "soft" leadership: it is the hard infrastructure of collaboration.

Boundary-spanning as the engine of collaborative governance

Boundary-spanning is where these ideas come alive in practice. It includes:

For boundary-spanning to be useful in neighbourhood services, it needs to operate at two levels:

• strategic boundary-spanning - leaders connecting systems and negotiating legitimacy across neighbourhood, ICB and local authority levels
• operational boundary-spanning - frontline professional joining services around local citizen need and lived experience.

Successful neighbourhoods will recognise these are core system functions, not nice-to-do add-ons.

Boundary-spanning across levels and structures

Conteh and Harding (2021) argue that in multilevel governance systems, boundary-spanning is vertical as well as horizontal: leaders must connect the micro level of neighbourhood action, the meso level of place-based coordination, and the macro level of regional and national policy.

In neighbourhood health systems, this means linking insight from local practice to the strategic levers of ICBs and national frameworks — ensuring that local experience informs system design and vice versa.

Klindt, Baadsgaard & Jørgensen (2023) add a structural perspective: partnership performance improves when organisations resource and institutionalise boundary-spanning. They call this coupling competence — the system’s ability to connect actors through stable yet flexible arrangements such as dedicated roles, shared data and managerial support.

So, boundary-spanning must be both relational and structural capabilities, not simply informal behaviour. It needs both relational legitimacy and structural support: people empowered to span boundaries, and systems designed to make that possible.

Relational governance and the emergence of learning capacity

When supported properly, boundary-spanning forms the basis of relational governance — governance that operates through trust, reciprocity and reflection rather than hierarchy.

From this, systems develop what is referred to as Absorptive Capacity. In the context of public service partnerships, Butler (2014) and Salehi (2012), describe it as the ability of organisations or networks to recognise valuable knowledge, assimilate it, and apply it for improved performance.

In neighbourhood health systems, absorptive capacity is inherently collaborative: it is generated through dialogue, translation and co-creation across organisational boundaries. It enables the network to learn collectively and adapt to changing circumstances — whether that means redesigning referral pathways, integrating community data, or co-producing prevention strategies.

Boundary-spanning and relational governance, then, are not just about coordination — they are the mechanisms through which systems learn and evolve. Systems start to learn faster than their environment changes — a hallmark of maturity in complex adaptive systems.

Practical “must-do” actions to embed boundary-spanning

1. Formalise boundary-spanning roles in job descriptions, partnership agreements and give these roles authority, time and visibility.
2. Resource relational work by allocating protected time and funds for cross-sector meetings, reflection and joint planning.
3. Design governance for connection, by establishing neighbourhood forums that blend decision-making processes with shared refection, that include both horizontal (sectoral) and vertical (system to neighbourhood) connections.
4. Develop capability and shared language by offering all partners development opportunities on negotiation, mediation and systems thinking, and by using shared frameworks (eg: outcome maps, logical models) to bridge professional dialects.
5. Create feedback and learning loops by using joint dashboards that are interpreted collectively (not competitively) and build rapid cycle reviews into innovations.
6. Invest in boundary spanning structural supports such as secure information sharing agreements, joint analytics and resourcing for joint posts.
7. Anchor relationships in purpose, but keeping the shared value proposition alive: why are we doing this together. Public value creation (not institutional preservation) must be a unifying motive.

Some pitfalls to avoid

Final reflections

All complex partnerships can succeed when they treat relationships as a key part of their infrastructure and capability. Neighbourhood health partnerships will be no different. Neighbourhood working is not a programme to be implemented, but a social process to be cultivated - boundary-spanning research shows that collaboration works best when relationships and structural enablers align.

Boundary-spanning is not peripheral, nice-to-do work - it is the work.

Author | Dr Terry Hudsen

Dr Terry Hudsen is a UK-based General Practitioner with a portfolio career that spans clinical practice, system leadership and cross-sector collaboration. 

In addition to his clinical work, Terry previously served as Chairman of NHS Sheffield Clinical Commissioning Group (CCG), leading strategic commissioning and system redesign, as well as leading the complex organisational change and transition to Integrated Care Boards. During this he led the establishment of joint commissioning arrangements between the NHS and local authorities and played a part in shaping national policy on maintaining joint health and care commissioning arrangements for local decision-making in place-based health and care systems. 

Following the dissolution of CCGs in 2022, he became lead for Population Health and System Development in South Yorkshire’s Integrated Care System, before leaving the NHS to establish an independent consultancy supporting NHS providers, local authorities and VCSE organisations with their capabilities for developing collaborative leadership, strategy and tackling wicked problems. 

In 2023, he became Independent Chair of the Bradford Safeguarding Adults Board, where he leads a statutory partnership which comprises partners from health, social care, local government, police, and the voluntary, community and social enterprise (VCSE) sector, focussing on preventing and responding to harm, neglect and exploitation of vulnerable adults. 

Alongside these roles, Terry is Clinical Lead for Primary Care and Neighbourhood Engagement and Support within NHS England’s mental health portfolio in the North East and Yorkshire, helping to drive transformation and strengthen collaboration between providers of health and care at local level. 

In addition to his medical qualifications from the University of Sheffield, Terry is a proud alumnus of The Open University Business School, where he earned an MBA with distinction in Leadership Practice. He is a Chartered Manager and a Fellow of the Chartered Management Institute. He is particularly interested in leadership across organisational boundaries, with his MBA dissertation focussing on collaboration between the NHS and VCSE sector. 

In all his roles he emphasises the power of partnership, culture and shared learning in creating sustainable change. Passionate about building a culture of curiosity and shared purpose across public services, he writes and speaks about adaptive leadership, collaboration and innovation in complex systems. His work aims to inspire leaders and practitioners to think differently, work collectively, and create meaningful impact in the communities they work. 

November 2025