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The Policy Watch series reflects on recent and forthcoming developments in mental health policy across the UK. This paper aims to review recent developments in mental health policy including the mental health implementation framework, draft Mandate to the NHS Commissioning Board, and proposals on shared decision making and integration of social and health care.

The paper reviews and summarizes recent developments in national mental health policy in England and their implications for mental health service provision.

The paper outlines several developments which contribute towards the realisation of the mental health strategy, No Health Without Mental Health.

The paper updates and discusses knowledge on recent and forthcoming mental health policy initiatives and cites recent evidence from Mind.

The purpose of this paper is to examine research evidence on collaboration between primary and adult social care in strategic, rather than operational, activities at two different time points, following large-scale changes within the health and social care environments; and discuss the prospects for the future.

This paper reports evidence from two substantial longitudinal studies (Dowling and Glendinning, 2003; Checkland et al., 2012) which followed the development of Primary Care Groups and Trusts (PCG/Ts) and Clinical Commissioning Groups (CCGs), respectively. Each used a combination of national surveys and local in-depth case studies to trace the early development of new structures and ways of working following major changes in the NHS and local government.

PCG/Ts had limited success in collaborating with adult social care partners. Health and Well-being Boards offer a new overarching organisational framework for collaborative strategic working between GP-led CCGs and adult social care services. Mandated joint strategic needs assessments also provide a shared framework within which commissioning decisions by both CCGs and social services are made. However, there remains evidence of long-standing barriers, particularly differences in geographic boundaries and in organisational and professional cultures.

Evidence from both studies is based on the early years of the respective new organisations; later evidence may have yielded a different picture.

This is the first paper reflecting on developments in strategic relations between primary and social care from researchers involved with two longitudinal investigations of the early development of PCG/Ts (1999-2002) and CCGs (2011-ongoing).

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.

NHS reforms in England led to the establishment of Local Education and Training Board (LETBs) to ensure the future supply of staff. LETBs have an important role in addressing health and social care integration. This paper aims to stimulate debate, ideas and opportunities to improve integrated workforce planning, practice and policy.

This is a thought leadership article which presents a distillation of key policy and strategy, drawing out implications for policy makers and workforce planners at a strategic level.

The paper describes and critically appraises the role of LETBs in supporting integration between health and social care. The key messages include: ensure social care and public health representation on the board, track education and training decisions against commissioning priorities, focus on outcomes and transition points, build health‐related skills in social care, support providers and use performance measures of integration.

LETBs need to demonstrate an open and transparent approach to workforce education and planning. All partners need to engage including social care and public health service commissioners and providers.

There is a substantial body of literature on integration, although much less is devoted to examining workforce. This article will be of particular interest to LETB leaders, those responsible for reviewing and assessing the performance of LETBs as well as social care leaders and workforce planners. In addition the article will be of interest to those supporting integrated workforce planning and development across the UK and internationally.

To provide an overview of the change to NHS Clinical Governance Support Team's Board Development Programme.

The background to the programme, the methods adopted by the Board Team and lessons learned are outlined. Commitment and active support at Board and senior levels are known to be essential for organisational change and, in order to help translate aims into strategic priorities and to implement these into improved services, the Clinical Governance Board Support Team was formed in 2000 as part of the overall NHS Clinical Governance Support Team (CGST). Its members provide advice and support to NHS personnel who are involved in improvements to health care services.

The team worked initially with Boards of acute NHS Trusts and later with Primary Care, Ambulance and Mental Health Trusts. Among the lessons learned from their own work and the increasing body of research‐based evidence is the importance of the leadership role of the Board in fostering a positive culture of change, enthusing and empowering staff. Other factors are the effectiveness of communication with external organisations, scrutiny of all points of contact with users of the services and involvement of users – patients and carers – at all stages. The Team evolved during the programme, strengthening its clinical base and introducing patients and carers as associates. In order to meet demand and increase capacity of the Team, learning materials have been developed and these and their experiences widely disseminated. An example of success is demonstrated by the progress made by a pilot cohort of Primary Care Trusts.

This review summarises the aims, objectives and progress of the work of the Board Development Programme.

The purpose of this paper is to consider whether the framework for integration initiated by the White Paper Liberating the National Health Service (NHS) is likely to be more successful than previous frameworks.

The paper formulates ten principles of integration derived from a historical literature review, and makes the comparison with principal features of new proposals for promoting integration between NHS and Local Government in England.

There is a relatively good fit between the principles and proposals but gaps were identified and implementation difficulties are already becoming evident especially in respect of the tension between localism and national accountability.

The conduct of the literature review is consistent with standard historical research methods but does not aim to comply with the protocols for systematic reviews in health sciences. It does not attempt to be based on a fully comprehensive search because of the time and other resources associated with its commissioning. Future empirical research will be necessary to establish the actual impact of the proposed legislative changes on relationships between the NHS and Local Government together with any changes to health and wellbeing outcomes at local level.

Local and national strategies for improving integration should be reviewed in the light of the principles set out here.

The paper should be of value to policymakers and policy analysts seeking to understand more systematically the implications of the current legislative proposals in the context of previous empirical and theoretical knowledge. It will also be of value as an up‐to‐date analytical account of an important dimension of the proposed health reforms in the context of longer term historical understandings frequently missing from the organisational memories of health and social care agencies.

The purpose of this paper is to present the findings arising from a three year research project which investigated a major system-wide change in the design of the NHS in England. The radical policy change was enshrined in statute in 2012 and it dismantled existing health authorities in favour of new local commissioning groups built around GP Practices. The idea was that local clinical leaders would “step-up” to the challenge and opportunity to transform health services through exercising local leadership. This was the most radical change in the NHS since its inception in 1948.

The research methods included two national postal surveys to all members of the boards of the local groups supplemented with 15 scoping case studies followed by six in-depth case studies. These case studies focused on close examination of instances where significant changes to service design had been attempted.

The authors found that many local groups struggled to bring about any significant changes in the design of care systems. But the authors also found interesting examples of situations where pioneering clinical leaders were able to collaborate in order to design and deliver new models of care bridging both primary and secondary settings. The potential to use competition and market forces by fully utilising the new commissioning powers was more rarely pursued.

The findings carry practical implications stemming from positive lessons about securing change even under difficult circumstances.

The paper offers novel insights into the processes required to introduce new systems of care in contexts where existing institutions tend to revert to the status quo. The national survey allows accurate assessment of the generalisability of the findings about the nature and scale of change.

This article describes a process undertaken to develop a set of commissioning principles to support the commissioning of secure learning disability services across England. The principles, shaped around the 11 competencies laid down in the World Class Commissioning competencies framework (Department of Health, 2008a), were produced following a scoping exercise that looked at provision and commissioning of secure learning disability services within each strategic health authority (SHA) area in England. Specific details were collected about types of services provided, including detailed service specification, quality indicators, how these (specialist) services link with local services (secure and non secure) and cost of services. Information collected about commissioning concentrated on strategic vision, practical commissioning arrangements, how the quality of services was monitored, how access to services was controlled and how ‘secure’ service users are reintegrated back into local (non secure) services and communities. This scoping exercise was augmented by qualitative data obtained from interview with a group of former service users. Themes generated through the interviews were integrated within the general guidance. A quality assurance framework based on the World Class Commissioning Competencies is proposed, against which specialist and local commissioners can benchmark their current commissioning arrangements.

People with dementia require care at home, in care homes and in hospitals, which has implications for the current and future workforce in health and social care. To inform regional workforce development planning in dementia care, Health Education East of England commissioned an organisational audit of current dementia training at NHS Trusts and in social care across Hertfordshire and Bedfordshire. The paper aims to discuss this issue.

Qualitative methods and non-probability purposive sampling were used for recruitment and data collection. The audit included NHS Trusts, local authorities, clinical commissioning groups, and health and social care organisations involved in commissioning and providing dementia education and training in the two counties.

Whilst there was considerable investment in dementia awareness training, learning was not targeted, assessed or structured to ensure on-going professional development.

This has implications for workforce development and career-progression for staff responsible for the care of older people with dementia. Conclusion: if a future workforce is expected to lead, coordinate, support and provide dementia care across health and social care, a qualifying curriculum could play a critical part in ensuring quality and consistency of approach and provision.

This paper makes a timely contribution to discussions on the skills and competencies needed to equip the future workforce for dementia care across health and social care.

This paper aims to discuss the importance of compassion in health care and experiences of Compassion Circles (CCs) in supporting it, placing this into the national policy context of the National Health Service (NHS), whilst focusing on lessons from using the practice in mental health care.

This conceptual paper is a discussion of the context of compassion in health care and a description of model and related concepts of CCs. This paper also discusses lessons from implementation of CCs in mental health care.

CCs were developed from an initial broad concern with the place of compassion and well-being in communities and organisations, particularly in health and social care after a number of scandals about failures of care. Through experience CCs have been refined into a flexible model of supporting staff in mental health care settings. Experience to date suggests they are a valuable method of increasing compassion for self and others, improving relationships between team members and raising issues of organisational support to enable compassionate practice.

This paper is a discussion of CCs and their conceptual underpinnings and of insights and lessons from their adoption to date, and more robust evaluation is required.

As an emergent area of practice CCs have been seen to present a powerful and practical approach to supporting individual members of staff and teams. Organisations and individuals might wish to join the community of practice that exists around CCs to consider the potential of this intervention in their workplaces and add to the growing body of learning about it. It is worth further investigation to examine the impact of CCs on current concerns with maintaining staff well-being and engagement, and, hence, on stress, absence and the sustainability of work environments over time.

CCs present a promising means of developing a culture and practice of more compassion in mental health care and other care contexts.

CCs have become supported in national NHS guidance and more support to adopt, evaluate and learn from this model is warranted. This paper is a contribution to developing a better understanding of the CCs model, implementation lessons and early insights into impact.