Introduction

‘Partnership’ and ‘modernisation’ were the leitmotifs running throughout the policy pronouncements of the first Blair government – across all service areas and sectors of the economy. ‘Partnership’ was acknowledged by one government minister as “one of those nice feely words beloved by politicians” (Boateng, 1999). In an effort to give a harder edge to what might otherwise be regarded as a rather woolly concept (together with its close cousin ‘joined-up government’), complexity theory was invoked to underline the need to see public services, in particular, as dealing with systemic ‘wicked’ issues; that is, problems spanning, rather than coinciding with, organisational and professional boundaries (Cabinet Office, 2001). This acknowledgement of problem and policy interdependence, together with the rejection of the competition inherent in markets, spawned the attendant New Labour lexicon of partnership, collaboration, coordination, joined-up government and – in the case of health and social care – integrated (‘seamless’) service planning, management and delivery. Moreover, the rhetoric was of promoting vertical partnerships (between centre and periphery or between local agencies and communities and publics), as well as horizontal partnerships across local organisations responsible for service commissioning and delivery.

In the latter context, the 1997 White Paper, The new NHS: Modern, dependable (DoH, 1997), set out what was described as the newly elected government's ‘Third Way’ of running the NHS. Adopting this Third Way of partnership constituted an explicit rejection of the “old centralised command and control systems of the 1970s” and the “divisive internal market system of the 1990s” (para 2.1). The new government was withering in its criticism of the latter:

In his foreword to the White Paper, the Prime Minister described it as “a turning point for the NHS. It replaces the internal market with integrated care”. Much of the early debate in pursuit of this goal was around the ‘Berlin Wall’ between the NHS and social services; in response to this specific interface, the 1999 Health Act (Section 31) sought to sweep away legal obstacles to closer joint working by permitting three new ‘flexibilities’ – lead commissioning, pooled (unified) budgets and integrated provision.