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The purpose of this paper is to take “a long view” of initiatives taken to promote integration between local government and the NHS with the objective of seeking to understand why they have achieved consistently disappointing results.

The paper's analysis is based on an historical overview drawn from official documents and empirical research from the time of the creation of the NHS in 1948. It primarily focuses on the principles shaping the separate but parallel reorganisations of 1974 and their continuing influence up to and including the current White Paper “Liberating the NHS”, and the Health and Social Care Bill.

The fundamental sources of integration barriers today lie in the foundational principles of basing their responsibilities on the skills of providers rather than the needs of service users and their organisational forms on separation rather than interdependence, with national uniformity driving the NHS and local diversity local authorities. In addition, frameworks for integration have been established on a paradigm of seeking to build bridges at the margins of organisations rather than seeking to interweave their mainstream systems and processes.

Future empirical research will be necessary to establish whether the currently proposed arrangements for integration do, in fact, experience the same limited results as previous ones.

Local and national strategies for improving integration should be reviewed in the light of the understandings set out here and local frameworks should seek to align and integrate mainstream systems and processes as far as possible. A thorough and dispassionate analysis should be conducted of whether a free‐standing, single purpose, national organisation still provides the most appropriate structure for delivering health services in light of changing needs, care models, and resources.

The paper offers a distinctive analysis of the possible causes of disappointing outcomes from successive attempts to improve integration. If accepted, it could lead to a radically different approach, first to integration and, ultimately, to the nature of the NHS and local government.

The purpose of this paper is to describe the experiences of Manchester Primary Care Trust (PCT) of driving improvement in quality and patient safety as commissioners in the English National Health Service (NHS). After the PCT's establishment in late 2006, considerable work was undertaken to develop and promote the role of Commissioner as the custodian of standards of services for its resident population. This required engagement with internal PCT stakeholders and a range of external stakeholders locally, regionally and nationally. The authors' experience should be of interest in the UK, and beyond given that many health systems have, or are moving towards, a commissioner: provider model.

This is a case study using self‐reported observational approach.

The authors' experience showed that commissioners can and should provide the leadership in driving quality improvements and patient safety, within their health systems. However, the challenges must not be underestimated, and the authors share some of the methods they used and lessons they learned.

There is a considerable interest in promoting quality through better commissioning of health care services. However, there is limited research into the impact and effectiveness of using commissioning as a lever. Given that in the NHS, and elsewhere in the world, commissioning is seen as the organising principle for health systems, such research and evaluation should be a priority.

This case study has valuable lessons for the new NHS and the findings are relevant to other health systems. There is a danger that the new NHS will repeat some of the mistakes of the past, and hopefully this case study can help avoid, or limit, the risks.

To the authors' knowledge there is no comparable piece of work, and the data/findings have not been published or reported comprehensively before. The paper should be of value to not just the NHS but to health systems generally, since commissioning seems to be the prevailing model for organising them.

The terms are not synonymous; their differences are mainly of function and areas of administration. Community Health is used in national health service law; environmental health to describe the residuum of health functions remaining with local authorities after the first NHS/Local Government reorganization of 1974. Previously, they were all embraced in the term public health, known for a century or more, with little attention to divisions and in the field of administration, all local authority between county and district councils. In the dichotomy created by the reorganization, the personal health services, including the ambulance service, may have dove‐tailed into the national health service, but for the remaining functions, there was a situation of unreality, which has persisted. It is difficult to know where community health and environmental health begin and end. From the outside, the unreality may be more apparent than real. The Royal Commission on the NHS in their Report of last year state that leaving environmental health services with local authorities “does not seem to have caused any problems”—and this, despite the disparity in status of the area health authority and the bottom tier, local councils.

Considers progress made in involving doctors in management, drawing on available ethnographies of local health‐care systems and a small‐scale study of consultants who have moved into clinical director roles or the equivalent. Specifically considers the extent to which the sample believes consultant roles have changed as a result of the recent reorganization of the NHS and general concerns about the involvement of doctors in management.

As it is now some time since the publication of the Health White Paper, and there is currently a pause in the progress of the Health and Social Care Bill through Parliament, it seems timely to look at how the proposed changes to patient and public involvement (PPI) may develop. This paper seeks to address these issues.

The paper examines the proposals for PPI set out in the legislation and uses the findings of the authors' recent research to examine them.

The paper argues that the legislation, as currently written, contains nothing that will guarantee a more effective engagement with either patients or the public.

This is a fast moving field at present, and the eventual outcome of this major reorganisation is unclear. This paper uses evidence from previous studies to provide an overview of the issues relating to patient and public involvement in the National Health Service and highlights the potential problems in the proposals as they stand at present.

The purpose of this paper is to explore the early experiences of those involved with the development of Clinical Commissioning Groups (CCGs), examining how the aspiration towards a “clinically-led” system is being realised. The authors investigate emerging leadership approaches within CCGs in light of the criterion for authorisation that calls for “great leaders”.

Qualitative research was carried out in eight case studies (CCGs) across England over a nine-month period (September 2011 to May 2012) when CCGs were in their early development. The authors conducted a mix of interviews (with GPs and managers), observations (at CCG meetings) and examined associated documentation. Data were thematically analysed.

The authors found evidence of two identified approaches to leadership – positive deviancy and responsible guardianship – being undertaken by GPs and managers in the developing CCGs. Historical experiences and past ways of working appeared to be influencing current developments and a commonly emerging theme was a desire for the CCG to “do things differently” to the previous commissioning bodies. The authors discuss how the current reorganisation threatens the guardianship approach to leadership and question if the new systems being implemented to monitor CCGs’ performance may make it difficult for CCGs to retain creativity and innovation, and thus the ability to foster the positive deviant approach to leadership.

This is a large scale piece of qualitative research carried out as CCGs were beginning to develop. It provides insight into how leadership is developing in CCGs highlighting the complexity involved in these roles.

Policy makers, practitioners and researchers have increasingly emphasised the need for both vertical and horizontal ‘integration’ and ‘integrated care’. This is not new; since the inception of the NHS wide‐ranging policies and programmes have sought to co‐ordinate services better. Current UK policy, however, tends to overlook this historical record and, in so doing, ignores potential learning from the past. We seek to help rectify this approach by reviewing historical (published and grey) literature over the past one hundred years, considering both the drivers for and the impediments to varied UK policy developments in integrating health and allied services. We aim to shed light on how the policy of integrated care has developed in the UK and draw out lessons for modern‐day policy makers.

The article seeks to explore the practical and theoretical implications of the ways in which senior figures in the National Health Service (NHS) interpret the role of the centre in relation to the delivery units of the health service. This is important in the light of recent plans for reorganisation of the NHS advanced by the new Conservative‐Liberal coalition government.

The article is based on interviews with civil servants and NHS staff at senior levels in the centre and in the strategic health authorities (SHAs).

It is found that, in practice, despite numerous attempts to separate out policy making from implementation/management, the two continue to be closely coupled and intertwined. Central staff and regional officials are found to be both steering and rowing.

Only a small selection of senior officials at the centre and only a small proportion of SHA senior managers and directors were interviewed.

The implications are far‐reaching. Unless special steps are taken, it seems likely that these senior officials, despite the creation of some new institutions and the curtailment of others, will continue to behave in broadly similar ways to those described here.

Empirical studies of the thinking, assumptions and behaviour of very senior officials in the health service are rare. The analysis in this paper explores the organisational conditions that shape the actions of these senior players.

The purpose of this paper is to explore the variety of mechanisms applied since 1991 to engage English and Welsh general practitioners (GPs) in local health services planning and implementation.

Three qualitative case studies.

The paper identifies three types of mechanism: separation, alliance and integration. “Separation” characterises the relationship between most GPs and health authorities during the 1990s; alliance refers to the cooperative arrangements between groups of GPs and health authorities such as GP commissioning pilots, total purchasing, primary care groups and local health groups; integration refers to the integration of most health authority functions with primary care organisations (primary care trusts – PCTs and local health boards). Alliance models appear to have been most successful in promoting GP engagement in local planning and implementation; the necessarily bureaucratic nature of PCTs an local health board has alienated many.

As yet, the National Health Service (NHS) lacks organisational arrangements which permit GPs a primarily clinical focus while ensuring that their knowledge and advice is available to those carrying out administrative functions. Practice‐based commissioning may provide a means of improving such arrangements.

The paper combines a number of features in health services and policy research. Few studies of primary health care organisations in the mid‐2000s have been undertaken; the Welsh NHS is very under‐researched; organisational analysis of the NHS is more often based on analysis from the outside rather than grounded in the felt experience of NHS personnel; and the historical perspective is often neglected.