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This Case Study examines a practical example of joint commissioning in action, in Easington, County Durham. It explores the collaborative processes and particularly the contribution of groups operating at strategic (district) and operational (village) levels. Key individuals made important contributions to the development of a truly ‘partnership’ way of working. Impacts on services began to be made but in the period of study this was more ad hoc than systematic. In spite of some tensions between the different levels of decision making and in the face of further organisational change, the challenge for Easington is to sustain the progress made and to move forward by making further inroads into needs which span various agencies' responsibilities.

This article is based on a review of reported studies of joint commissioning in practice, which are surprisingly few in number. It concludes that there is little solid evidence that the process leads to benefits for service users, but there is evidence of its resulting in improved inter‐agency working. A second article in a subsequent issue of this journal will go on to consider whether the new partnership flexibilities offer the potential to learn from this evidence.

In the second of two articles, the authors consider whether the evidence of joint commissioning's limited success has influenced the new partnership flexibilities. They conclude that, while they offer significant opportunity, their positive elements may be undermined by lack of recognition of the unavoidable complexity of the organisational environment in the health and social care field.

The Health and social care needs of older people cover a large number of different systems, resulting in inadequate priorities for their needs. There is no single acknowledged ‘big issue’ for older people's health and social care. We need concerted effort to achieve clarity and consensus on key issues such as quality, rights, entitlements, and levels of funding. A national initiative, led by Government, is required, built on the involvement of older people and a genuine respect for them.

This Paper Looks at Health Action Zones, to be established from April 1998 with the intention of moving towards prevention of illness and promotion of health. It suggests how localities could begin to conceptualise a programme of work, and warns of some of the difficulties they may meet.

Findings and good practice are reported from a project promoting engagement of PCTs with the health experiences of people with learning disabilities. Project work was most successful where it linked into mainstream NHS priorities, using good information and specialists' expertise to support mainstream practitioners.