Whole system approaches

Both Partnership and Total Place are whole system approaches but they cover different priorities. They are two major themes being focused on and they are complementary but there are also tensions between them in practice.


The approach of successive governments has emphasised the need for joined up services. ‘Our health, our care, our say’ (2006) emphasised the importance of partnership working between NHS bodies and local government to achieve joined up service delivery tailored to the needs of citizens, for example by aligning the planning and budgetary cycles between local government and health.

Partnerships were also core to the aims set out in the 2006 Local Government White Paper, Strong and prosperous communities, which further strengthened partnership working. The White Paper gave a clear signal of the role for local authorities to be 'place shapers' and strategic leaders for their community, to develop a vision for their area and work to make it happen imaginatively and jointly to make localities better places in which to live and work.

Creating Strong, Safe and Prosperous Communities (2008) provided guidance to local authorities and their partners relating to the Local Government and Public Involvement in Health Act 2007. The guidance covered Local Strategic Partnerships, Sustainable Community Strategies, the new duty to involve, Local Area Agreements, the revised best value regime and commissioning.

Policy announcements in 2010 have developed the ideas of place shaping and total place introduced by previous governments. Plans for the transformation of health and social care are based on local authorities and GP consortia working more closely together to identify local needs through the joint production of a JSNA, to establish local priorities and to commission service to address those needs, working with a range of organisations, including charities, social enterprises, mutuals and co-operatives, which the government wishes to see promoted and encouraged to participate in all activities, from assessment to provision.

Total Place and Localism

The government’s statement on public health, Healthy lives, healthy people (DH, 2010), emphasises the focus on to communities as the drivers of public health priorities, rather than centralised targets, as has been the case in the past, with priorities set by everyone within a community, not just those who currently use health or social care services.

DCLG has announced that from April 2011 the first phase of 16 areas covering 31 councils and their partners will be put in charge of ‘Community Budgets’ which pool various strands of Whitehall funding into a single ‘local bank account’ for tackling social problems around families with complex needs. The Government intends to roll out community budgets nationally by 2013-14, with the aim of putting councils and their partners in the driving seat by pooling funds for tackling the needs of families into one budget so communities can develop local solutions to local problems.

The Localism Bill was introduced to Parliament in December 2010 and included proposals for community empowerment and greater accountability to local people. Of huge significance to commissioning activity is the aim of diversifying the supply of public services to increase choice and achieve a better standard of public services.

The ‘Big Society’ agenda is supported by the Commissioning Green Paper, which sets out the Government’s intention to create an enhanced role in public service delivery for voluntary and community sector organisations. This will inform a Public Service Reform White Paper to be published in 2011. This will clearly have implications for the role of commissioners in market development.