What’s this project all about?
Leeds is showing how better use of data can help neighbourhood teams support people before problems reach crisis point.
Partners across the area have developed a shared approach to data that gives health, care and community organisations a clearer picture of local needs. The work is helping neighbourhood teams identify people who may need extra support, target interventions more effectively and better understand what is making a difference in local communities.
At the heart of the approach is the Leeds Data Model - a secure platform that brings together information from across health, care and community services into one trusted source. It is supporting the wider neighbourhood health approach in Leeds, which puts people and communities at the heart of how services work together.
“Neighbourhood health is about understanding the people and communities we serve and responding to what matters most to them,” said Graham Hyde, Head of Business Intelligence. “By bringing information together from across organisations, we can build a much fuller picture of local need and make sure support reaches people at the right time.”
Creating a shared picture of local service use
Before this work began, information was held by different organisations in different systems and formats. This made it difficult for partners to build a full understanding of people’s needs or use insights consistently across services.
To address this challenge, Leeds developed the Leeds Data Model, a secure cloud-based platform that links information from a wide range of partners. The data is pseudonymised, which means linked together with all personal details removed, to protect privacy while still allowing an understanding of trends and patterns.
The city used the Leeds Data Model to develop the Curiosity Tool, an easy-to-use dashboard that allows frontline teams to explore data without needing specialist analytical skills.
“Good neighbourhood health relies on local knowledge, trusted relationships and good information,” said Graham. “The Curiosity Tool helps teams combine what they already know about their communities with data and insight, so they can make better decisions together.”
Supporting more personalised neighbourhood care
The shared data model is helping neighbourhood teams identify groups of people who may benefit from proactive support. This includes people living with frailty, complex long-term health conditions, mental health conditions and other risks that can affect their wellbeing. By identifying these groups earlier, teams can offer support before issues escalate and help people stay healthier for longer.
The approach also allows teams to focus on the priorities that matter most in their local communities while working within a shared framework. For neighbourhood health teams, this means more joined-up working between health services, social care, local authority teams and community organisations. It also supports a more personalised approach, recognising that different communities face different challenges.
“Every neighbourhood is different,” said Graham. “Having access to shared insight means local teams can focus on the issues that matter most in their communities and work together to tackle inequalities in health outcomes.”
Building trust across organisations
Strong partnership working is a key factor behind the project’s success. Senior leaders from the NHS, council and voluntary and community organisations have all supported the vision for shared data. Alongside the technology, Leeds has invested in trusted relationships, shared governance arrangements and collaborative analytical expertise.
The Curiosity Tool was co- designed with frontline staff, helping ensure it is practical and useful in day-to-day work.
Graham said: “Making data accessible is just as important as improving data quality. By involving users from the start, we are helping to build confidence, improve understanding of data and encourage wider adoption across partner organisations.
Measuing impact and learning what works
The Leeds Data Model is helping teams evaluate the impact of neighbourhood interventions over time.
By using consistent coding and tracking activity before and after interventions, teams can see how support may be influencing demand across GP practices, community services and hospitals. This growing evidence base is helping Leeds strengthen prevention-focused services and make more informed decisions about future investment.
“Neighbourhood health is about moving from reacting to problems to preventing them wherever possible,” said Graham. “The more we understand what works, the better we can invest in approaches that help people live well and remain independent for longer.”
Looking ahead
Leeds is continuing to expand and strengthen the model. Cross sector information governance is in place to enable record level housing and health data to be linked. This could support earlier identification of risks linked to housing conditions or instability and enable more joined-up support for families and households.
The city has developed its predictive capabilities, helping teams recognise signs of rising risk months or even years before someone reaches crisis point.
As the evidence grows, the Leeds Data Model is expected to play an increasingly important role in shaping future investment decisions and supporting the continued development of neighbourhood health across the city and beyond.
The project demonstrates how strong partnerships, shared data and local insight can come together to improve outcomes for people and communities. By putting neighbourhoods at the heart of decision-making, Leeds is helping create more connected, preventative and personalised care for residents.
You can also read the 'bringing together information to support people earlier' case study as a PDF.