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English governance has repeatedly had a tendency to veer between national, regional and local centres of power and influence. This has often led to profound disagreements, sometimes even open conflict. National policy guidance is usually helpful, if developed through consultation, to steer a clear, coherent direction for the system. But a narrow, excessively top‐down, mechanistic target‐driven approach can lead to a prevailing culture of ticking boxes at the expense of real patient priorities. Government ministers and civil servants, however, are often caught in a tension between being too dogmatic, or alternatively too flexible and giving responsibility to local agencies, whereupon people may complain about a ‘postcode lottery’ in services. Balancing perspectives and narratives in a coherent way for policy development and implementation and service improvement is a major challenge of leadership. The creation of the National Institute for Mental Health in England (NIMHE) was designed to bring together the local, regional and the national in a form that would see policy and practice mutually developed and nurtured at all levels of governance.

This rapid assessment aims to focus on the perceptions of healthcare staff from Welsh Health Boards on the National Service Framework (NSF) for Older People.

A questionnaire was sent by email to key colleagues in each of the seven Health Boards. This was crucial for this rapid assessment and conferred the additional advantage of also allowing for correspondence to be undertaken. Anonymity was crucial to allow colleagues to score their returns honestly.

Overall, the position was equivocal and the impact of the NSF was perceived as too difficult to assess. The most promising element of the NSF appeared to be a perception on the impact on joint health and social care working.

A rapid assessment exercise, using existing networks that are built on trust, can yield valid and useful information which can help policy development.

The NSF urgently needs to provide evidence of positive impact. The next stage, based on a focussed approach, offers an opportunity to progress this.

For the first time, a rapid assessment has been undertaken on the Welsh NSF. This inexpensive and readily achievable approach has advantages.

The National Service Framework for Older People (DoH, 2001) is a ten‐year plan which aims radically to improve health services for older people. Central to the plan is the belief that older people should be involved as ‘genuine partners’ in the implementation process. In this article we describe how regional and local implementation teams in the North West of England are working in partnership to develop a coherent and sustainable strategy for engaging with older people.

This paper seeks to report key findings of a study, whose purpose was to: understand what helps or hinders the commissioning and provision of integrated services for people with long‐term neurological conditions (LTNCs); identify models of best practice from the perspectives of people with LTNCs and the professionals who work with them; and develop a benchmarking system to assess the extent to which these models are available in England.

The research had three main components: a rapid systematic literature review of evidence; in‐depth case studies of six neurology “service systems”; and a survey of all English PCTs to audit progress towards implementation of the National Service Framework (NSF) for LTNCs.

A number of elements that contribute to the experience of continuity and three service models that incorporate these elements were identified: community interdisciplinary neurological rehabilitation teams; nurse specialists and proactive, holistic day opportunities services. The survey results reinforced many of the case study findings, particularly around the varying levels of service available depending on diagnosis and location, and problems of access even where high‐quality services existed. The paper concludes that the systematic approach to delivering treatment and care for people with LTNCs envisaged in the NSF has not yet been achieved.

This study uses a mix of methods to assess progress towards national service improvement, based on evidence from people with LTNCs and those who work with them. As such, it provides a comprehensive benchmark at a critical point in the implementation of the NSF for LTNCs.

This paper explores how Standard 8 of the NSF for Older People can help local services and communities address the health inequalities agenda. We introduce the initiatives being undertaken by eight pilot sites participating in the Pre‐Retirement Health Check Pilots Initiative managed by the Health Development Agency, and share some of the emerging themes from their work. Finally, we reflect on the links between the work of the pilots and the requirements of Standard 8, as well as the wider policy and practice implications for sustaining this work beyond the life of the project.

Joint reviews are an approach to partnership working between those involved in inspection and regulation. They provide great opportunities and some challenges. This article describes a case study of the review of the National Service Framework for Older People. It discusses culture and commitment, organisational imperatives and governance.

The promotion of public mental health is a challenging endeavour for policy actors and stakeholders. In particular, the implementation of public mental health initiatives highlighted in Standard One of the National Service Framework for Mental Health has been poor and patchy (Department of Health, 2004a). This paper attempts to illuminate the complex process of public mental health policy implementation at local level through the exploration of stakeholders' actions.An exploratory case study design was selected, focusing on one local health and social care community within inner London. A conceptual framework about policy implementation and the concept of partnership working are used to shape the analysis of the empirical findings.This paper addresses the challenges associated with the promotion of public mental health initiatives within one local NHS health and social care community. It attempts to increase the understanding and insights into public mental health policy and practice at local level from a policy implementation standpoint. Using an empirical case study of public mental health in an English locality, some of the key issues explored in this paper are about perceptions of public mental health concepts among key policy actors and also stakeholders' behaviour in Local Implementation team (LIT) partnerships. Furthermore, the authors address the issue of how local policy actors engage the local community in supporting the needs of vulnerable groups such as service users and black and minority ethnic (BME) groups.Although functional partnership are essential for the promotion of public mental health initiatives, the interdependencies of the stakeholders, competition for resources, power dynamics and the difficulty of engaging a diverse range of voices have a significant limiting effect on achieving successful policy implementation on the ground.

This article discusses the role of clinical risk management in the implementation of the National Service Framework for Coronary Heart Disease (NSFCHD). It considers the practical difficulties faced in meeting NSF standards, and proposes a combined, complementary approach involving primary and secondary care. While the NSF makes no explicit reference to clinical risk management, the risk manager has an important role to play in ensuring that an adverse event reporting system is in place and its role fully accepted by clinicians. From a medico‐legal standpoint, a commitment to auditing outcomes and maintaining good clinician‐patient communication is viewed as essential. It concludes that doctors’ and patients’ interests are best served by clinicians adopting a clinical risk management approach to implementing the NSFCHD.

The number of children in England, and the number who may need additional support from services, is large and growing. At the latest count there are approximately three million children aged under five, 6.4 m aged 5‐14, and 3.1m young people aged 15‐19. Children and young people from ethnic minority backgrounds make up about a fifth of the total population under 20 ‐ much higher than for other age groups. In total there are reckoned to be 12m children, 400,000 children in need, 59,700 looked after children, 320,000 disabled children, 600,000 live births a year and approximately one million with mental health disorders (DoH, 2003a).No single agency or profession can cater for such a large and disparate number of individuals, but increasingly their needs are crossing traditional organisational and professional boundaries. The partnership imperative that has become so influential in services for adults is now set to re‐shape the domain of children's services. Accordingly, the aim of this article is to examine the genesis of this imperative, to explore the emergent policy responses and to gauge their likely effectiveness.

One of the key initiatives of the National Institute of Mental Health in England National Workforce Programme (NIMHE NWP) has been to explore the development and sustainability of the non‐professionally qualified workforce (NPQW). Both the National Service Framework (NSF) for Mental Health (Department of Health, 1999) and the wider Department of Health Changing Workforce Programme (Department of Health, 2001) provided a unique opportunity to start this process off.