Neighbourhood Health in UK Devolved Nations: Thinking Through Archetypes and Partnership Working

Part 2: From Archetypes to Instruments (and Why Blended Finance Keeps Coming Up)

What I have been trying to build is a process that moves archetype thinking from concept to operation. The surprising part has been realising that blended finance, a domain I used to work in, offers structural logic that transfers directly to neighbourhood health partnerships. Not as a metaphor, but as a method.

The connection between blended finance and neighbourhood health is not obvious. Blended finance is about structuring capital flows to projects that private investors avoid because the risk-return profile does not work (OECD, 2018; Attridge and Engen, 2019). Neighbourhood health is about delivering care closer to communities to unburden traditional models heavily titled to acute care and which is currently struggling in the UK due to populations complex needs and weak institutional infrastructure.

But the structural problem is identical. Both are trying to allocate resources in contexts where standard mechanisms fail. Both require categorisation to operate efficiently. And both succeed or fail based on whether the people being served have genuine voice in system design, or whether participation is performative.

What I have been developing is a six-step process that brings archetype thinking, systems logic, and partnership design together. This is provisional. But here is where I have landed.

Step 1: Identify the Community Archetype

The first move is classification. Not demographics. Not administrative boundaries. Archetypes.

I use two composite indicators. One measures health system status: prevalence of preventable conditions, strength of primary care infrastructure, public health capacity. The other measures attractiveness to health stakeholders: existing partnership density, funding flows, presence of private or impact sector players, community organising capacity.

Why both? Because they tell you different things about readiness and need.

A community might have very poor health system status (high need) but strong stakeholder attractiveness (strong voluntary sector, existing partnerships, funding already flowing). That suggests different opportunities than a community with equally poor health status but weak institutions and low external interest.

This is the aha moment: the archetype is not just about need. It is about the relationship between need and the infrastructure available to respond to it. That relationship determines what kind of partnership is viable.

An urban super-diverse community with strong community organisations is ready for partnerships focused on cultural brokerage and health literacy. The infrastructure exists. The challenge is engagement. A post-industrial legacy community with weak institutions needs a different kind of partnership, one that is about building institutional capacity and economic security alongside health interventions. You cannot skip the institution-building phase.

The archetype clarifies what is structurally possible, not just what is aspirationally desirable.

Step 2: Define the Health Issue

Once the archetype is clear, you can define the health issue with precision. Not “cancer outcomes are poor,” but “late-stage diagnosis of preventable cancers is driven by health literacy barriers and mistrust of mainstream services in communities where English is not a first language.”

The issue definition is nested in the archetype. That means the intervention has to be as well. You cannot take a health literacy programme designed for a diverse urban population and deploy it in a rural sparse community where the challenge is not cultural engagement but geographic access and social isolation. The structural drivers are different. The intervention logic has to reflect that.

This sounds straightforward, but in practice, national programmes often try to apply the same intervention across radically different contexts because that is what the evidence base supports. What I am suggesting is that evidence needs to be interpreted through the archetype, not applied universally. The intervention that works in one archetype might fail in another, not because the evidence was wrong, but because the structural conditions were different.

Step 3: Prioritise Financing and Operational Challenges

This is where blended finance logic becomes directly operational.

In blended finance, the core question is: what prevents private capital from flowing to socially valuable projects? The answer is usually some combination of perceived risk, insufficient return, or transaction costs that make small-scale investment uneconomic (Convergence, 2019).

In neighbourhood health, the analogous question is: what prevents effective interventions from being deployed at scale in this archetype?

For a rural sparse archetype, the answer might be high per-capita delivery costs. Services are expensive when populations are dispersed. Monitoring is harder when sample sizes are small. Traditional programme budgets do not work because the unit economics are unfavourable.

For an urban super-diverse archetype, the challenge might be securing sustained funding for culturally tailored outreach when outcomes take years to materialise and evaluation frameworks are not designed to capture qualitative shifts in trust and engagement.

For a post-industrial legacy archetype, the challenge might be that health interventions alone do not shift outcomes unless economic insecurity is also addressed. But there is no natural funding mechanism that blends health budgets with economic development budgets at community scale.

Different archetypes surface different financing constraints. The partnership design has to respond to those constraints, not ignore them. This is the insight blended finance has already learned: you cannot solve a financing problem by pretending it does not exist. You have to design instruments that address the constraint directly.

Step 4: Evaluate the Potential for Innovation Vehicles

Not every neighbourhood health challenge requires financial innovation. Some require better coordination. Some require clearer governance. Some just need more consistent political attention. But where financing challenges are structural and persistent, innovation vehicles can unlock resources that traditional mechanisms cannot.

This is where Macmillan’s systems investment model becomes relevant. Rather than funding isolated service interventions, Macmillan invests in system-level change: partnership infrastructure, data integration, workforce development, policy influence. The model works because it treats health systems as investable entities, not just service delivery platforms.

The question for neighbourhood health is: can we structure investment vehicles that back community-level systems change, not just programmatic outputs?

I use three evaluation criteria:

• Is the underlying neighbourhood health concept sustainable beyond initial funding?
• Is there potential for increased efficiency by engaging private or impact sector players?
• Are there credible local partners with aligned incentives and capacity to absorb investment?

Where all three conditions are met, innovation vehicles merit serious consideration. Where one or more is missing, traditional partnership models might be more appropriate. The point is not to force innovation for its own sake. It is to match the instrument to the structural challenge.

Step 5: Shortlist Blended Instruments

If the archetype and financing analysis point towards innovation, the next step is instrument selection. This is where Critical Systems Heuristics (Ulrich, 1983) becomes essential.

CSH asks: who holds power in this system? Whose interests are served? Whose are marginalised? In neighbourhood health partnerships, these are not philosophical questions. They are operational ones. If a national organisation designs a partnership model based on archetype logic, who decides what the archetype actually is? Who decides which interventions align with it? Who evaluates success?

If all that decision-making power sits with the national organisation, the archetype framework is just sophisticated top-down programming. But if the archetype framework creates structured space for communities to define priorities, then it becomes something different. The archetype is not a prescription. It is a constraint that clarifies roles and creates accountability.

The instruments I have been considering include:

Social impact bonds: These work where causality is clear, outcomes measurable, evaluation feasible. Reducing emergency hospital admissions through enhanced community nursing might fit. The challenge is that many neighbourhood health outcomes are long-term and diffuse, which makes impact bonds hard to structure. They work better for acute, measurable interventions than for systemic prevention.

Revolving concessional loans with NO interest repayment to community organisations: If a community organisation delivers a preventive service that generates measurable NHS cost savings over time, a concessional loan allows upfront investment with Principal Repayment from future savings. This shifts the relationship from grant dependency to investment partnership. It also changes accountability. The organisation is not just reporting activities. It is managing a financial instrument. Traditional concessional grants are non-repayable, but for the uniqueness of this condition, it should be aligned for Principal pay back.

Pooled funding vehicles: These blend public health budgets, Integrated Care System resources, philanthropic capital. The pooling spreads risk and allows smaller, experimental interventions to be funded without requiring each one to justify itself individually. This is particularly useful for post-industrial legacy or coastal deprivation archetypes where institutional capacity is weak and early-stage investment carries high perceived risk.

Participatory grant-making: Communities co-design spending priorities within a national funding envelope. This is not blended finance in the technical sense, but it applies the same logic of distributed decision-making and risk-sharing. Power shifts from programme managers to residents. The archetype still provides structure (you are operating in a rural sparse context, so geographic access matters), but the specific priorities are community-defined.

The shortlist has to align with the archetype (what works structurally in this kind of community) and the financing challenge (what resource gap needs filling). A rural sparse archetype with high delivery costs might benefit from pooled funding. An urban super-diverse context with strong community organisations might be better suited to participatory models that leverage existing social capital.

Step 6: Identify Activities for Further Engagement

The final step is role clarity. What should national organisations actually do?

In some contexts, the role is convening and brokering partnerships. In others, it is providing technical assistance on instrument structuring or evaluation design. In others, it is stepping back entirely and allowing local actors to lead.

This is not abdication. It is precision about where value is created and where it is destroyed. National organisations are well positioned to build archetype taxonomies, facilitate cross-archetype learning, and de-risk early adopters. They are poorly positioned to micromanage local delivery. Attempting to do so usually destroys value.

The framework clarifies where national organisations add value and where they do not. That clarity matters for partnership design. If roles are unclear, partnerships drift into vague accountability, and that is where most eventually fail.

The Unexpected Transfer: Why Blended Finance Logic Works Here

The juxtaposition of blended finance and neighbourhood health was not one I anticipated. They operate in different domains. But the structural logic is transferable.

Both attempt to allocate resources where traditional mechanisms fail. Both require categorisation to operate efficiently. Both succeed or fail based on whether power is genuinely redistributed or merely rebranded.

What blended finance learned through practice is this: categorisation precedes instrument selection. You do not start with a preferred tool and search for projects that fit. You start with the category of opportunity, understand its constraints, then select the instrument that addresses those constraints most directly.

This does not make neighbourhood health easier. But it does make it more honest about what is required to work effectively across heterogeneous populations at national scale. And that honesty, more than any specific instrument, might be the most valuable thing archetype thinking offers.

 

I work at Macmillan Cancer Support in a team focused on multisectoral partnerships and systems change. If you are a national organisation working in the neighbourhood health space and this thinking resonates, I would be interested in a conversation. Please drop me a note

References

Attridge, S. and Engen, L. (2019). Blended Finance in the Poorest Countries. London: ODI.

Convergence (2019). The State of Blended Finance. Toronto: Convergence.

OECD (2018). Making Blended Finance Work for the Sustainable Development Goals. Paris: OECD Publishing.

Phillips, R. and Pittman, R. (2009). An Introduction to Community Development. London: Routledge.

Roseland, M. (2012). Toward Sustainable Communities. Gabriola Island: New Society Publishers.

Ulrich, W. (1983). Critical Heuristics of Social Planning. Bern: Haupt.