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The publication of the Coalition Government's NHS White Paper seems to be proposing a revitalised relationship between adult social care and the NHS. This article explores these proposals and concludes that, although they hold promise, they may be insufficiently robust to overcome the priority the White Paper gives to competition rather than collaboration. It is suggested that social care is in danger of becoming a handmaiden to health care in an increasingly privatised market that could move towards an insurance‐based model of funding.

The NHS White Paper (Department of Health, 2010) seems to herald the introduction of a greater role for local government in running health services in England than at any time since 1948. Partnership working between the NHS and local authorities is to be elevated to a higher level and a greater role for elected members is to be introduced to address the ‘democratic deficit’ in the centralised NHS. All of this will be underpinned by a raft of new inter‐organisational arrangements. Although these changes do indeed constitute a significant change, this article suggests that the impact may be less than many hope and expect.

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.

This paper reviews the contents of the White Paper — the NHS Review, ‘Working for Patients’ published in January 1989’ — and the initial reactions to it. It is easy to fault the White Paper for its unevenness and incompleteness. On the other hand, just because it leaves so many loose‐ends and is non‐prescriptive in detail, there is scope to fashion what happens next in an experimental, evolutionary way. The author seeks to move the debate on from analysis of the document's strengths and weaknesses to consideration of what those who care about the British National Health Service can do to shape the future that the White Paper has begun to create.

The article follows up a prospective article published just before the Election with a review of the Coalition's vision for health and social care. It concludes that, despite risks of increased fragmentation, there are new opportunities for integration in both commissioning and provider functions. Local authorities should move quickly to influence and lead the new partnerships.

Choosing Health is the first government public health white paper since Saving Lives: Our Healthier Nation, published in 1999. It aims to make the NHS ‘a health service, not a sickness service,’ and is strongly influenced by the Wanless reports. This paper presents a critical review of the main elements of the white paper that relate to mental health, and sets out the actions that policy makers and service delivery organisations need to take to build genuinely mental health promoting public services within a mentally healthy society.

Although Presented AS evolutionary, the White Paper on the NHS could prove revolutionary in its impact. The ‘third way’ approach to the service, based on partnership and driven by performance, is not without potential problems over structures and boundaries at both local and national levels. The delivery of seamless service is a very positive goal, but it is too early to predict how far it will be achieved.

The authors of the NHS White Paper ‘Working for Patients’ apparently wish to create a UK health care market, ie a network of purchasers and providers who contract with one another. However the rules governing the behaviour of these actors may create a market which is not competitive but highly regulated. This thesis is explored here in the context of self‐governing hospitals (SGHs). The characteristics of a market are set out elsewhere. Even though the White Paper is terse and incomplete, the rules which will determine the behaviour of SGHs are clearly set out and may inhibit considerably the freedom of managers. To explore these constraints and other areas in which the rules of management may have considerable impact on economic efficiency, a series of questions is posed.

The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended.

The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.’s “receptive contexts for change” and four of the eight factors stood out as especially important and form the basis of the paper.

The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the outcomes in respect of transformational change.

The chief limitation is the credibility and authenticity of the interviews captured at particular points in time. These formed the datebase for subsequent analysis. The authors sought to guard against possible bias by supplementing interviews with observational studies and focus groups as well as running two dissemination events at which emerging findings from the study were subjected to independent external scrutiny and comment. These events provided a form of validation for the key study findings.

The research findings demonstrate the importance of context for the likely outcome and success of complex transformational change initiatives. These require time to become embedded and demonstrate results especially when focused on changing culture and behaviour. But, in practice, allowing sufficient time during which the organisation may remain sufficiently stable to allow the change intervention to run its course and become embedded and sustainable is highly problematic. The consequence is that bold and ambitious efforts like the NETS are not given the space and stability to prove themselves. Too often, politics and external environmental pressures intrude in ways that may prove dysfunctional and negative.

Unless a different approach to transformational change and its leadership and management is adopted, then changing the NHS to enable it to appear more responsive to changing health care needs and expectations will remain a cause for concern. Ultimately the public will be the losers if the NHS remains insensitive to changing needs and expectations. The patient experience was at the centre of the NETS programme.

The study is original insofar as no other has sought to evaluate the NETS independently and over a reasonable time period. The research design, based on a mixed-methods approach, is unusual in evaluations of this nature. The study’s conclusions are not so original but their value lies in largely confirming and reinforcing the findings from other studies. It perhaps goes further in stressing the impact of politics on health policy and the negative consequences of constant organisational change on attempts to achieve deep change in the way the NHS is organised and led.

For the past eight years the Centre for Corporate Strategy and Change has conducted a major stream of research looking at service change in the NHS and aspects of the implementation of the NHS reforms (Pettigrew, Ferlie and McKee, Ashburner, Ferlie and Fitzgerald, Bennett and Pettigrew, Ferlie and Bennett). This paper is based on the emerging findings from a new empirical study of the development of the process of contracting in the NHS.