Expert comment: How streamlining council processes could help tackle health inequalities

In a new report, Sophie Cloutterbuck, Director of London Engagement, identified how to turn local insight into action

Date: 6 November 2026

Over the past year, Sophie Cloutterbuck, Director of London Engagement at London Metropolitan University, evaluated community engagement across six boroughs in the capital.

This included four National Institute for Health and Care Research (NIHR) Health Determinants Research Collaborations (HDRCs) and two comparators.

HDRCs are partnerships funded by the NIHR which build research capacity and evidence-informed decision-making within local government.

Her research comes as councils and NHS partners respond to the Government’s Neighbourhood Health Framework, driving new ways of working ahead of locally owned neighbourhood health plans in 2027-28.

Here, Sophie summarises some of her lessons for councils attempting to turn local insight into action.

Engaging local voices is essential

Across the country, inequalities in health outcomes reflect the differences in power, resources, and living conditions people face. Because the root drivers of these inequalities lie in housing, local environments, and local economies, local authorities have a central role in tackling them.  

However, councils cannot always see how these wider pressures are being experienced day to day. Community insight can reveal where services are falling short, which groups are being missed and how local pressures are interacting. Engaging local voices is therefore essential to tackling health inequalities effectively. 

From my research, it was clear residents and community organisations held detailed local knowledge that formal data alone could miss. Councils are increasingly finding ways to bring that knowledge into research and decision-making, but sometimes practical barriers get in the way.  

Community insight is strongest when it shapes the agenda  

The best examples I saw gave communities a role before priorities were set, as engagement becomes much more valuable when residents help shape the questions, rather than simply responding to them. 

From paid community researchers shaping priorities to collaborative boards approving projects, these models prove resident expertise uncovers key insights traditional evidence misses. 

To facilitate this, councils should step back from an “expert” posture to share influence and hear challenge, training middle managers to value community expertise and embed it in day-to-day practice. 

Internal systems can make or break good engagement 

Even where the ambition was strong, internal processes can get in the way. Procurement and payment systems designed for large organisations placed a disproportionate burden on small voluntary groups, while departmental silos could prevent information gathered through public health work reaching colleagues in housing or other services. 

Small, practical changes make a huge difference. Pre-funding community groups removes financial risk, while lighter procurement and faster payments stop small organisations being weighed down by processes built for large contractors. 

I also saw community-led approaches encounter systems designed primarily to control institutional risk – often at the expense of community momentum and trust. Senior leaders must be prepared to challenge processes that protect the organisation at the expense of effective partnership working. 

Finally, system translators or "ferrymen" prove essential for bridging institutional divides. By connecting communities, councils, and academics, they align different speeds and languages so local insight isn't lost across organisational boundaries. 

Trust depends on communities seeing what changes 

Perhaps the clearest lesson was that engagement cannot end when the meeting does. Residents need to see the results of their participation, and action must follow when engagement brings immediate problems to light.  

Asking residents to discuss long-term health inequalities while issues such as damp, broken lifts or food insecurity remain unresolved can quickly undermine confidence in the process. Creating clear routes for those concerns to reach the right part of the council is essential for building credible, longer-term relationships.

Fair payment matters for the same reason: paying people properly for lived-experience contributions recognises their value and helps include those unable to volunteer their time for free. 

Taken together, these lessons show what meaningful engagement requires in practice: insight that can move across departments, partners that can participate without being held back by council processes, and residents who feel valued and can see that their contribution leads somewhere. As neighbourhood health plans develop, these are the foundations councils will need to build on. 

A longer version of this article first appeared in the MJ. It draws on some of the findings from Sophie’s recent report published by The Local Policy Innovation Partnership (LPIP) Hub.