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The Government's vision for social care highlights choice and control by individuals. This paper draws on findings from a King's Fund study and considers how far collaborative commissioning is ready to meet the challenges of ensuring a diverse menu of flexible, integrated services for people using either direct payments or individual budgets. It concludes that more needs to be done to build commissioning skills, and other investment in developing the care market will be needed to deliver the Green Paper's aspirations.

This paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning.

A case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five “best practice” sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups.

Very little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties.

Joint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked.

It is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop.

This is one of the first large‐scale studies of joint commissioning conducted in England.

Telford and Wrekin Council and PCT have developed a Health and Well‐being Strategy that includes all health and council services that contribute to this area, including secondary health care. This article describes the challenges that they faced in understanding and agreeing shared priorities and how they used this whole‐systems framework to keep a clear focus on what local people want and need, bringing together and making sense of national policy such as World Class Commissioning and Putting People First.

The purpose of this paper is to present an evaluation of a collaborative commissioning approach to improve quality and experience and reduce cost within integrated health and social care.

A multi-method approach is used involving qualitative interviews, documentary analysis and non-participant observation.

The findings suggest that the approach provides a suitable framework for the collaborative commissioning of integrated health and social care services.

Further research is now needed to provide a definitive evaluation of its value outside of Wales.

With the significant scrutiny on health systems, the approach demonstrates effectiveness in securing quality improvements, achievement of recognised care standards and patient outcomes, while providing scope for financial gains and a goal for stakeholders to engage in effective communication.

This research presents an innovative method for collaborative commissioning and reveals activities that appear to contribute to more effective commissioning processes.

A survey of integrated working between primary care trusts (PCTs) and adult social services across England was undertaken in December 2009 and January 2010. The survey results are presented in the context of the history of integrated working between health and social care, and the recent policy announcements of the Conservative‐Liberal Democrat Coalition Government.

The purpose of this paper is to share the challenges of, and learning gained by a voluntary sector organisation, Coventry Rape and Sexual Abuse Centre (CRASAC) in providing integrated care to victims of sexual violence.

The paper first considers the big picture, focusing on the current UK public sector commissioning environment, the policy commitment to integrated care, and challenges a current focus on definitions of integration that do not consider wider determinants of health and well-being. As an example of client groups who may not meet narrow criteria, but require person centred coordinated care, the needs of victims of sexual violence are explored, illustrated by a case study within CRASAC.

Challenges faced by CRASAC include identifying responsibility for specialist commissioning, maintaining strategic partnerships and a lack of cross-sector understanding of the needs of victims of sexual violence. Key learning points are the need to form strategic alliances and partnerships, to lobby and influence decision makers, to develop monitoring tools that demonstrate impact on long-term client outcomes and to constantly raise awareness of the needs of victims of sexual violence. Final reflections focus on the questions these issues raise for the future of specialised integrated care in the voluntary sector.

The paper is of value to commissioners in health, social care and the criminal justice system, in addition to providers of services that are in contact with victims of sexual abuse. These include health, criminal justice, education, police and social care, alongside other voluntary and community sector organisations.

The purpose of this research is to identify novel ways of tackling health inequalities of underserved populations. It explores the opportunities presented by the changes in health and social care legislation to employ historically underused services, such as police custody healthcare providers, in addressing health inequalities.

This research analyses the policy approaches to tackling health inequalities in the UK in the past 40 years with an emphasis on those experienced by the people detained in English police custodies. It analyses the current model of healthcare in police custody and proposes a novel integrated model of care and joint commissioning opportunities in funding it.

Policies to tackle health inequalities have largely failed, as they became entrenched. But recent changes in the health and social care legislation in England offer opportunities to address them by employing historically underused healthcare services, such as those operating in police custodies.

The research does not touch upon ethical considerations related to the patient privacy aspect of integrated care. Interventions by and interactions with police custody healthcare providers would be visible to all professionals with access to the patient’s health record. As with all novel interventions or innovative models of care, the effectiveness of such clinical interventions remains to be established by further research. It opens a new line of research on quality improvement through integration of care and explores understudied aspects of joint commissioning of integrated care.

It offers health commissioners and public health leaders the opportunity to employ police custody healthcare services in reaching their population health management objectives and meeting their health inequalities objectives at local level. It also gives police and crime commissioners the opportunity to address the health drivers of criminal behaviour that overlap with health inequalities. It offers funding opportunities presented by jointly commissioning services at lower costs to both police and health commissioners alike. It improves the health outcomes of historically underserved populations by facilitating access to health and social care services and facilities.

Reducing health inequalities and disparities in health outcomes can decrease the costs of the healthcare services over the long term and might contribute to reducing criminality by addressing inequities and some health drivers of criminal behaviour.

The paper explores understudied opportunities offered by the recent changes in health and social care legislation in England and includes underused resources to tackle health inequalities.

The purpose of this paper is to explore power-resistance plays, or organisational change (OC) politics, from a discourse theory perspective to deepen our understanding of the political and emotional dimensions of these phenomena.

The paper deploys Laclauian concepts of hegemony, fantasmatic narrative and empty signifiers alongside a recently-developed logics of critical explanation approach in the case study of an English local authority formulating a project of integrated commissioning in response to austerity.

The paper demonstrates how OC politics are played out in multiple ways, from social and political negotiations over the meaning of commissioning to the refuelling of the authority’s fantasmatic narrative.

The paper’s key value is to illustrate how and why discourse theory can contribute, alongside other discursive frameworks, to the in-depth qualitative and political study of organisational issues such as change.

This paper aims to report results from a national survey of primary care trusts (PCTs) that explored the strategic, organisational and practice context of services for people with long‐term neurological conditions (LTNCs). It seeks to provide benchmarks for integrated service provision and to discuss possible reasons for the variability in progress.

Earlier phases of the research identified three models of care that promoted continuity of care for people with LTNCs: community interdisciplinary neurological rehabilitation teams, nurse specialists and pro‐active day opportunities. Based on this evidence, a benchmarking questionnaire was developed and a telephone survey of PCTs in England undertaken in 2009.

The survey found that the prevalence of models of good practice varied widely across and within PCT areas. Strategic support and commissioning arrangements were also variable. A little over half of responding PCTs had completed a joint strategic needs assessment (JSNA) that included a reference to LTNCs and a quarter of PCTs had no joint commissioning arrangements in place for LTNCs. The complex interplay between strategy, organisational structures and models of delivery, in a context of competing priorities, may account for this variation and patchy progress.

Service provision for people with LTNCs is an under‐researched area, despite having major implications for long‐term care and support. The paper will be valuable to policy makers and commissioners in benchmarking organisational activity and models of good practice for integrated services.

The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing.

The review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings.

The core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings.

Addressing the implementation of OBC in adult social care in England in the context of extra care housing.