Going to Where the Work Is Needed: Rethinking How We Deliver Prevention

Across the country, there is growing investment in wellbeing hubs — centralised spaces designed to bring services together and offer a visible access point for health, wellbeing and prevention. This direction of travel aligns with wider NHS and Integrated Care System (ICS) ambitions to simplify access, reduce fragmentation, and support earlier intervention.

In many contexts, these hubs have clear benefits. They can improve coordination, support multidisciplinary working, and offer a recognisable place people can turn to for help.

But as our work through the Eastern Devon Health Inequalities programme is beginning to show, centralised models alone are unlikely to reach everyone — particularly those most affected by inequality.

This is not a new insight. The Marmot Reviews consistently highlight that social, economic and environmental factors shape health inequalities, and that action must be taken as close to people’s everyday lives as possible. Likewise, NHS prevention policy increasingly recognises the importance of community-based approaches, social connection, and local assets in reducing long-term demand on services.

What early engagement is telling us

Over the past quarter, All About The Place has been working alongside communities across a mix of urban neighbourhoods, coastal towns, market towns and rural villages. This early phase has focused on listening, relationship-building and understanding how communities already support health and wellbeing — rather than introducing predefined interventions.

What is beginning to surface is a consistent pattern.

Much of the most impactful preventative work is already happening outside formal service settings:

• In trusted community hubs such as churches, community centres and resident-led spaces.

• Through grassroots youth, wellbeing and peer-support initiatives.

• Via relationships built over time by volunteers, youth workers, community organisers and local leaders.

These activities often align closely with NHS prevention priorities — mental health, physical activity, social isolation, youth wellbeing — yet they frequently sit below the radar of formal systems. They are rarely captured in population health intelligence or JSNA processes.

The limits of “come to us” models

Wellbeing hubs tend to work best for people who:

• Feel confident navigating systems.

• Trust statutory or semi-statutory environments.

• Can travel and self-refer.

• Recognise their needs early and feel comfortable asking for help.

However, both the Marmot and NHS Core20PLUS5 guidance remind us that those experiencing the most significant inequalities often face the highest barriers to access. These can include stigma, past negative experiences, lack of trust, mobility issues, caring responsibilities, or simply not seeing services as “for people like them”.

Our engagement suggests that some of the people who most need preventative support are the least likely to walk through a door, even when that door is well-designed and well-intentioned.

A complementary approach to prevention

Rather than framing this as an either-or choice, our work highlights the value of a dual approach.

Alongside centralised wellbeing hubs, there is substantial merit in going to where the work is already happening — supporting prevention in place, within existing community settings and relationships. This aligns closely with NHS ambitions for neighbourhood health, place-based working, and upstream work.

This is the premise underpinning our approach:

• Strengthening community capability rather than creating parallel services

• Animating participation and quieter voices through relational methods, such as Quiet Voice

• Supporting co-design with residents and community organisations, not consultation done to them

• Helping community-led activity connect with NHS, Public Health and JSNA priorities

By working in this way, we can:

• Reach residents who are less visible to centralised models

• Reduce barriers linked to trust, stigma and confidence

• Support earlier intervention before needs escalate

• Build sustainable, locally rooted prevention capacity

Building from what already exists

A recurring theme in both the NHS prevention strategy and the Marmot Reviews is the importance of building on existing assets rather than starting from scratch. Communities are not empty vessels waiting for services to arrive. They already hold social capital, lived experience, informal support networks and innovation.

What is often missing is the infrastructure to connect these assets, align them with system priorities, and make their contribution visible and sustainable.

The next phase of our work focuses on:

• Creating regular spaces for shared sense-making between communities and system partners

• Supporting proportionate ways of evidencing impact and social value, without overburdening local groups

• Strengthening partnership pathways rather than adding new layers of delivery

• Exploring how different prevention models — hubs, outreach, community animation — can work together rather than in isolation

Prevention as a shared endeavour

If prevention is to be equitable, effective and sustainable, it cannot sit solely in buildings or programmes. It needs to live in relationships, neighbourhoods and everyday places where people already feel safe and connected.

Wellbeing hubs play an important role. But so does meeting people where they are — and recognising community-led work as essential prevention infrastructure, not an optional extra.

Our early learning suggests that the strongest outcomes will come not from choosing one model over another, but from intentionally aligning them, grounded in local context, lived experience, and the shared ambition to reduce long-term health inequalities.