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The purpose of this paper is to examine the motivations behind public sector spin outs, focusing on the Right to Request policy, which enabled NHS staff to set up their own social enterprises to deliver healthcare services.

The paper draws on empirical data gathered from 16 in‐depth interviews with individuals who had led a Right to Request proposal.

Motivations to spin out of the NHS into a social enterprise were often “empathetic” in nature, built around the good of the service for staff and users. Alongside this, some felt “pushed” out of the NHS as a result of government restructuring policy, with social enterprise offering the only hope to survive as an organisation.

The study captures a particular point in time and there may be other perspectives that have not been included.

The paper is of use to academics, policy makers and practitioners. It provides an important contribution in thinking about how to motivate public sector staff, especially those from a health profession, to consider spinning out into social enterprises.

The paper is the first to look at the motivations of healthcare spin outs through the Right to Request programme. The findings are related to previous literature on social entrepreneurship within public sector settings.

This paper seeks to reflect on English care trusts as an example of a structural approach to integration.

All current care trusts' chief executives were invited to participate in a semi‐structured interview exploring their experiences. Themes from the interviews were combined with findings from literature and policy review.

The current care trusts can identify a number of advantages from combining health and social care into a single organisation. Equally, they also experienced many of the anticipated difficulties, and in hindsight half of those interviewed would recommend other options to achieving better integrated working. Whilst the “commissioning” function of care trusts will not survive beyond March 2013, “provider” care trusts look set to continue and indeed expand their service delivery. They will be joined both by new integrated social enterprises delivering health and social care.

The experiences of care trusts show the limitations of a single organisational structure as a means to achieve better integration and the impact of a changing national policy landscape on local initiatives. The findings suggest that the current legal flexibilities for integrated working should remain to enable local areas to decide how best to achieve their priorities and to realise the importance of addressing local cultural, practical and leadership issues along with structural barriers.

This paper provides a reflection on the ten years since the option of care trusts were available in England and adds to the current literature which focuses on individual care trusts' development and impact.

The purpose of this paper is to explore the relationship between general practitioners (GPs) and social care professionals by reflecting on a project (the Home Truths project) which sought to improve joint working between general practice and social care though an action-research process.

iMPOWER's Home Truths project involved gathering local data regarding joint working in local areas and using this data as a catalyst for change. The Institute of Local Government Studies and the Health Services Management Centre at the University of Birmingham were asked to act as a critical friend to the project. This involved supporting the design of the data collection, offering advice on the process and to carrying out a short evaluation of the impact of the first wave. The paper reflects on the collected data from the sites and information from the impact evaluation.

The paper highlights the poor quality of the relationship between GPs and social workers. Findings that illustrate this include GPs’ poor knowledge of social care services; a perception that social care services were of poor quality and rating the quality of their relationships with social workers as poor. However GPs felt that knowing more about social care could help prevent their patients going into residential care earlier than necessary and wanted to work more closely with social care to exploit the benefits and opportunities. The interventions that have been put in place to try and improve relationships focus on the day-to-day working lives of the professionals rather than attempting to introduce new initiatives.

The response rate from GPs in the areas was low (average response rate was 10 per cent in each area) and it may be that only those GPs who are interested in working with social care responded. The initiatives that have been developed appear to be reasonable responses to the issues identified. However, a lack of discrete outcomes through which to measure improvement will make it difficult to demonstrate the impact of the interventions.

This paper underlines that despite many years of policy makers promoting better integration, the relationship between the key gate-keepers within the health and social care systems is still poor. The findings from the Home Truths surveys and action plans has gone some way to address the gap identified in the evidence base about the relationships between GPs and social workers.

The third sector has been promoted by progressive English governments as a provider of health and social care services for people with mental health difficulties. This article aims to consider the assumptions that lie behind these polices and reviews the evidence that third sector organisations can be said to have a “unique” role and approach. The challenges and opportunities of the current market‐based reforms for the third sector are discussed.

The article is based on literature reviews of the third sector's role in mental health care and commissioning of third sector organisations.

The third sector delivers a range of mental health services in England, in particular those related to accommodation, advice, advocacy and employment. Its activity extends into other roles such as campaigning and development of new approaches to care and support. Evidence of the distinctiveness of the sector as a whole is limited, but there are examples of such organisations providing innovative and user‐led services. Market‐based reforms are seen as posing a threat to smaller organisations in particular but personalised approaches (including allocation of individual budgets), outcome‐based payments and a need for large‐scale service redesign are seen as offering considerable opportunity for expansion.

For the new market to include a strong third sector will require leadership within organisations, a collaborative approach within the sector, and commissioners that understand and engage positively with the sector in all its diversity.

This article draws together the research literature on the third sector's engagement in mental health and the impact of market‐based reforms and in doing so provides original value in the fields of mental health and third sector studies.

The purpose of this paper is to explore change within the commissioning of third sector mental health services in England.

A case study methodology based on survey and interview data of a sample of third sector organisations and commissioners within an English conurbation.

Normative commissioning models based on sequential cycles were not fully implemented with the main focus being on the procurement and contracting elements. There were examples of commissioning being an enabler of service improvement but overall it seems to have been limited in its ability to bring about whole system change. Barriers included commissioners’ capacity and competence, ineffectual systems within their organisations, and fragmentation in commissioning processes between user groups, organisations and sectors.

The case study conurbation may not represent practice in all urban areas of England and there may be particular issues of difference within rural localities. The view of private and public sector providers and those working in Commissioning Support Units were not sought.

To lead whole system change the commissioning function needs to be adequately resourced and skilled with better integration across public sector functions and organisations. Greater emphasis needs to be placed on implementing the full commissioning cycle, including the engagement of relevant stakeholders throughout the process and the practical application of outcomes.

This research adds to the limited body of empirical work regarding commissioning in mental health.

Resource redeployment may occur when a firm exits from one line of business and enters another. We suggest that when multiproduct firms identify opportunities in new high-growth markets, their entry will occur alongside exit from low-growth markets when the firm is resource-constrained. For our sample of over 47,000 high-tech US firms in CorpTech from 1993 to 2004, 5% of the firm-years include simultaneous entry and exit at the product market level, which we term “product turnover.” Firms are more likely to engage in product turnover when there is a larger spread between the highest and lowest growth rates for the product markets in the firm’s portfolio. This effect is strongest for small- and medium-sized firms, which tend to be privately held. Therefore, future research on resource redeployment might find fruitful ground in samples of mid-size firms.