Welcome to this second special edition of the Partnership Update, dedicated to West Yorkshire Neighbourhood Health

Preventing falls before they happen – how a Keighley pilot is helping people stay safe, active and independent

A six-month pilot in Keighley has shown how health, care and community organisations can work together to identify people at risk of falling and offer support before a crisis happens.

The proactive falls prevention pilot used health data to identify older people who may be at increased risk of a fall, then connected them with a range of support. This included home assessments, medication reviews, exercise and education sessions, digital health monitoring and community activities.

The project brought together Modality PCN, Keighley Healthy Living, Bradford Council, Bradford District Care Trust, Airedale NHS Foundation Trust and West Yorkshire Integrated Care Board (ICB) to offer targeted support to people identified as being at increased risk of falls. Elements included:

• home assessments: 383 people received a visit from a GP or healthcare assistant to identify falls risks and wider health and care needs. This led to medication reviews, cognitive assessments, ReSPECT planning and referrals to other services where needed
• falls prevention exercise: Keighley Healthy Living delivered a nine-week programme combining seated exercise, practical information and peer support, covering topics such as staying active, making the home safer, medication, nutrition and hydration
• remote monitoring: Airedale NHS Foundation Trust’s Digital Care Hub offered eligible people 24/7 monitoring through the Luscii app, using daily health readings and symptom checks to identify when clinical support might be needed
• community engagement: Bradford Council worked with local community groups to raise awareness of falls prevention and connect people aged 50 and over with local activities, exercise and wellbeing support

Together, these approaches aimed to identify risks earlier, build people’s confidence and strength and help them stay safe and independent at home.

You can read the full case study on the West Yorkshire Neighbourhood Health pages on the Partnership’s website.

Other recent stories showing Neighbourhood Health in action include:

• people living with severe frailty and respiratory disease in East Leeds receiving more coordinated support through an Advanced Respiratory programme, helping them stay well at home and access the right care more quickly. Delivered through the Cross Gates and Seacroft Local Care Partnerships, the work brings together a care coordinator, community matron and a network of health, care and voluntary sector professionals around each individual. See the ‘advanced respiratory initiative helps people in East Leeds stay well at home’ case study on our Neighbourhood Health website pages
• residents in Seacroft having their say on the future of local health and care through the Seacroft Speaks Think Tank Project. Through regular group sessions, residents have explored how organisations such as the West Yorkshire Integrated Care Board, primary care networks and local care partnerships work, as well as what a neighbourhood health approach means in practice. The opportunity also provides one-to-one, community-based support. See the ‘Seacroft Speaks is helping residents shape the future of local health and care’ case study on our Neighbourhood Health website pages
• personalised digital support at The Old Fire Station helping Marina rebuild her confidence and stay connected after losing her husband. Marina moved from drop-in sessions to weekly one-to-one appointments, where she could learn practical skills at her own pace. She can now use online banking, shop online, navigate using digital maps and keep in regular contact with family in the United States. The sessions have also given her a reason to leave the house, meet someone and learn something new, helping reduce loneliness and isolation. Read Marina’s story
• partners bringing information together to help Neighbourhood Health teams in Leeds understand local needs and act earlier. The Leeds Data Model securely links information from health, care and community services, while the Curiosity Tool gives frontline teams an accessible way to explore local trends and identify where extra support could make the biggest difference. See the 'bringing together information to support people earlier' case study on our Neighbourhood health website pages
• a Neighbourhood Health team in Pontefract and Knottingley using data and joined-up support to help people living with COPD stay well and avoid hospital where possible. Since December 2025, health and care professionals have worked together to identify people at higher risk, offer extra COPD reviews and provide health coaching for issues such as anxiety and breathlessness. See the 'Pontefract and Knottingley neighbourhood team’s proactive approach to supporting people with COPD' case study on our Neighbourhood Health case study pages

Neighbourhood Health in Calderdale builds on strong foundations

This blog comes from Jonathan Hammond, Deputy Chief Executive, Calderdale and Huddersfield NHS Foundation Trust 

In Calderdale, Neighbourhood Health is not something we have had to start from scratch. For many years, our health, care, voluntary and community sector partners have worked closely together to support people in a more joined-up way. What we are seeing now is the next stage of that journey, bringing greater focus, stronger collaboration, and a shared ambition to improve outcomes for our communities.

Earlier this year, we formally established the Calderdale Provider Collaborative, bringing together organisations from across health and care to work differently around the needs of local people. This collaborative approach supports the ambitions of the national Neighbourhood Health agenda by helping us move away from organisational boundaries and focus instead on what matters most to our communities.

One of the key principles of neighbourhood health is providing care closer to home, preventing ill health where possible and intervening earlier when support is needed. In Calderdale, we are already seeing how this can make a real difference.

Our Community Diagnostic Centre in the centre of Halifax makes it easier for people to access tests and investigations in a local setting, reducing the need for hospital visits and helping patients receive care in a more convenient way. At the same time, our integrated community teams continue to support people with complex needs in their own homes and communities, often preventing avoidable hospital admissions. These services are particularly important for people living with frailty, who benefit from coordinated care provided by professionals working together around the individual.

As we approach winter, Neighbourhood Health becomes even more important. Every winter brings additional pressures across health and care services. The challenge is not simply about managing demand, it is about ensuring that people receive the right support, in the right place, at the right time.

We have seen the value of this approach through initiatives such as acute respiratory infection (ARI) hubs, which provide timely assessment and treatment closer to home, helping people access care quickly while reducing pressure on hospitals and emergency departments. Working alongside community services, primary care, local authorities and voluntary sector partners, these models demonstrate what can be achieved when organisations come together around shared goals.

For me, the biggest strength of Neighbourhood Health is that it recognises no single organisation can meet the needs of our communities alone. Success depends on partnership, trust and a willingness to work differently.

Calderdale has a strong track record of collaboration, and that gives us confidence for the future. By continuing to build on those foundations, we can create services that are more accessible, more preventative and more responsive to the needs of local people. That is good for patients, good for staff and good for the sustainability of health and care services across our place.

Neighbourhood Health is not a new destination for Calderdale - it is the next phase of partnership working that is already delivering benefits for our communities and helping us prepare for the challenges ahead.

Futures as a way forward for West Yorkshire

In West Yorkshire, we are using the Futures Collaboration Platform to support integration, awareness and understanding across and between all organisations that support our 2.7million population. This includes local authorities, hospitals, schools, third sector, GPs and everyone in between.

We have two main spaces - Joined up care West Yorkshire (predominantly signposting) and the Insight Library (hosting a diversity of resources to appreciate the views and composition of our population).

Details of how to join are on Futures.