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This article explores the front‐line experience of a two‐tier shire county, Nottinghamshire, in using a whole‐systems working approach to the promotion of independence and well‐being for older people. Nottinghamshire has been one of the eight national pilot sites for LinkAge Plus. The experience of managing a whole‐systems approach in practice in implementing LinkAge Plus is explored. The importance of ensuring the systematic engagement of older people in the process is emphasised. The article describes six learning areas which helped the development of preventative and well‐being services in the context of whole‐system working and older people's engagement.

Abstract This article looks at the benefits of and obstacles to using a whole systems approach to plan and deliver personality disorder services. It does so using the example of the Leeds Managed Clinical Network, a community pilot service that employs whole system working to support people with personality disorder.

Whole system working is critical to improving health and social care services while using scarce resources more efficiently and this article aims to look at the urgent need to develop measures for it. It seeks to describe the development of a simple, practical, set of measures for benchmarking and analysing local use of key whole system resources as the basis for discussion and planning. Practical and usable tools are needed urgently as national measures are not available at present and key resource decisions need to be made now.

The paper looks at a simple framework for looking at integration in localities and some proposed measures as the basis for discussion. It describes the development and application of a simple, practical set of measures to use locally in the absence of a national set. It uses nationally available, comparable measures wherever possible to minimise work. It briefly describes how the comparative data enables localities to identify key differences in use of resources and outcomes and areas for improvement.

Taking a whole system, whole person approach and applying it across localities provides a useful framework to help local health and social care systems focus on improving patient outcomes while reducing unnecessary costs – particularly unnecessary use of high cost institutional care. The measures including the Audit Commission whole system measures identified key issues re different use of resources, costs and outcomes between localities. This article looks ahead to the implications of greater personalisation of services and the need to develop more effective information systems based on the individual patient which allow more rigorous measurement of service effectiveness including outcomes as well as activity.

In the absence of national measures of whole system integration, this paper describes how a simple, practical framework and measures were developed to analyse use of resources and identify key areas for improvement. It can be used by localities to provide a quick benchmark of use of resources and outcomes (especially whole system use of expensive institutional resources) to support value for money and service effectiveness work. It describes how it worked in practice and looks at how information systems could be further developed in line with personalisation to allow ongoing improvement based on individual outcomes, costs and service effectiveness.

This study describes the need to develop whole system measures to show the effectiveness of moves towards integration. In the absence of national measures, it describes the development of a simple set of local whole system outcome measures based on a framework based on recent work on whole system integration. The paper uses both health and social care evidence and summarises key elements that work. It shows how the measures have been applied in practice in localities as a first step in a local system improvement programme.

Top‐down or outside‐in change methodologies are increasingly seen to be ineffective. Systems thinking suggests that change in organizations is a much less straightforward and more subtle phenomenon than previous models allow. Since the late 1970s and as organic metaphors have become used more, the concept of organizational learning has emerged as central to the issue. However, an understanding of how this may take place is still undeveloped. Recently technologies for whole systems development have emerged based on Weisbord′s dictum that for change or learning to occur we need to “get everybody into improving the whole”. Whole systems development can offer a way to realizing the learning organization. Provides a case study of whole systems development in action within Walsall Metropolitan Borough Council in the UK. Begins with a brief account of the ideas on which whole systems development is based and concludes with a commentary on the case study.

This paper considers intermediate care as part of a whole‐systems approach to care. It argues that this perspective allows a wider appreciation of the potential benefits of intermediate care, and that this would also be a welcome feature in future research studies. The paper draws on an evaluation of intermediate care in Cornwall and outlines the central role of intermediate care co‐ordination in the whole system. The example of residential rehabilitation is then used to examine how an individual service relates to the system as a whole. Finally, factors that may also influence local systems such as partnership working and rurality are considered; these are seen as important considerations for any other authorities which might seek to replicate the Cornwall approach to intermediate care.

The modes of governance underpinning public sector services have been reshaped several times in the post‐war period, leaving a mixture of command and control, marketisation and partnership working. There is now a call for a new and ambitious phase that might be termed ‘whole systems working’, and the most ambitious focus for this phase is the Every Child Matters reforms being ushered in under the Children Act 2004. This article describes the whole‐systems nature of the changes and identifies a range of difficulties that need to be addressed.

Rhetoric and reality lead separate lives when it comes to integrating health and social services in Scotland, and it is making planning and implementation difficult for practitioners of integration. This paper is a collaboration between a practitioner and two academics who teach, research and write about integration. It explores the views of other integration practitioners about the policy, language and nature of integration, and the issues practitioners are currently grappling with, especially how the policy language of ‘integration’ fails to connect with integration in practice. It appears that ‘integration’ has less to do with broad policy aspirations and principles of service (re)organisation, than with the specific aims, objectives and outcomes of individual projects delivered in very specific circumstances. Acknowledging the localisation of integration, and allowing the time for productive problem solving which can generate a new language, ought to be essential elements of integration.

Pressure for reform and change in the public services will continue irrespective of the political composition of governments. There are many interrelated pressures for change, some of the key ones being the need to contain public spending (to under 40 per cent GNP?) in the face of ever increasing global competition, changing demographic and employment patterns, increasing need and demand for services, and the need to find innovative solutions to obdurate problems of local levels ‐ health, housing, community safety, unemployment and so on. Above all, this will require greater productivity; changing skill boundaries, demarcations and mixes; far greater applications of technology and innovative community‐based multi‐agency working ‐ beyond rhetoric. Unfortunately, much current research, scholarship and commentary is “locked into” individual public sectors ‐ health, education, public administration and so on. This means that it is likely to be informed by existing frames of reference which already lie within these sectors. A wider flow of ideas, theory and critical analysis across private and all public sectors could lead to the development of new paradigms of insight, understanding and practice. This would prove a further impetus for a bottom‐up social movement with a communitarianist agenda. Unfortunately this is most unlikely to be promoted top‐ down because most politicians are also “locked into” the binary thinking of Fordist modernism.

This paper considers the impact of reimbursement on delayed transfers and whole‐systems planning. The paper argues that making hospital discharge work with the focus only on the interface between health and social care will have limited and short‐term results. More radical cultural change is needed to tackle the problems of an ageing society. The paper draws on recent thinking which challenges the way in which services are currently provided to older people, and calls for new ways for services to be commissioned and provided. The paper advocates changes towards community‐based processes and pathways, across a wide range of services and within a much broader whole‐systems framework, to support independence.

Purpose – To report on how service changes can be accelerated by working with large groups that represent all parts of a complete healthcare service or care pathway, during specific events, and using well‐defined facilitation techniques. Design/methodology/approach – Case examples are cited from the Clinical Governance Support Team's “protected time” programme and subsequent work, and specific quotes and examples from large group events are used to describe the potential impact of the approach. Findings – Established group facilitation techniques can be adapted for use in the context of a large group representative of a whole clinical system or pathway, to accelerate service improvement. Originality/value – The paper reports on the practical findings from Clinical Governance Support Team group facilitators working on large group events from a number of UK NHS Trusts.