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The policies of personalisation and choice have reawakened the underlying policy debates about the relationship between the ideologies of service reform and the implementation of policies that affect disadvantaged people. Service users themselves are responding through a range of initiatives that link self‐management, personal budgets, advocacy and the emerging aspiration for ‘co‐production’. By bringing together learning from a community of practitioners this paper identifies both the opportunities for partnership, including with multi‐disciplinary teams, and the threats of new forms of testing that have deep roots in social policy debates. In so doing it begins to identify the real choices that users, citizens and professionals now face.

This paper is about purpose… or, rather, the confusion of purposes. If we are to continue to invest in ‘leadership development’ in public services, what's the reason? How will we know, in respect of outcomes, that spending money on selected individuals will result in public value?‘Value for money’, ‘best value’, ‘service excellence’, ‘patient/client‐centred’; the phrases spill out comfortingly, especially at leadership conferences or on management and professional development programmes. Are these mere words, or part of something big and important? Are they jargon and tokenism, or a positive, meaningful set of aspirations and goals that inform public leadership at the beginning of the 21st Century? ‘Yes’ and ‘Yes’.

The success of the forthcoming policy promoting health care outside hospitals will depend on achievement of fully integrated services, especially for individuals at risk of hospitalisation. Using as a case study the evaluation of a community response team, this paper argues that past attempts to achieve such service integration with frail elderly people have been short‐lived because of the impact of restructuring of the major commissioning organisations. While the effectiveness of integrated service developments can be demonstrated, the positive benefits have not been sustained, and valuable learning has been lost. By identifying key aspects of organisational memory, the paper proposes a more relationship‐focused approach to reform in which multi‐agency teams are given the time to establish personal services for vulnerable people.

Will Hutton is chief executive of The Work Foundation, an independent, not for dividend research‐based consultancy that is an influential voice on work, workplace and employment issues in Britain. Will began his career as a stockbroker and investment analyst, before working in BBC TV and radio as a producer and reporter. Prior to joining The Work Foundation, Will spent four years as editor in chief of The Observer.Will has written several best‐selling economic books including The World We're In, The State We're In, The State to Come, The Stakeholding Society, On The Edge with Anthony Giddens and The Writing on the Wall. In addition, he won the Political Journalist of the Year award in 1993. Other roles that Will performs outside The Work Foundation include: Governor of the London School of Economics; Honorary Fellow, Mansfield College, Oxford; Visiting Professor, Manchester University Business School and Bristol University. He is also a member of the Scott Trust and a Fellow of the Sunningdale Institute.

This paper details the emergence of a user‐led movement focused on self‐management that is beginning to transcend the usual categories of patient, carer and user. It argues that this coalition will begin to drive integrated care, by putting citizens at the centre of a working partnership with providers and practitioners, and by providing the leadership that will enable an integrated service system through co‐creation and collaborative learning.

This short informal paper introduces a research project carried out at The Centre for Business Research, based at Brighton Business School entitled: “Total Quality Management in the Supply Chain”. The project is funded by the ACME Directorate of the Science and Engineering Research Council.