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The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to integrate assessments.

This paper is a review of data from a survey of specialist clinicians' involvement in the single assessment process for older people.

The paper finds that clinician involvement was limited, with assessments not changing to a discernable degree and little involvement of older people. Changes to assessment were predominantly related to paperwork. However, the use of standardised tools by clinicians did increase. The use of shared record systems with social services was significantly associated with involvement.

Clinicians have previously not been engaged in policies around integrated assessments. Factors that can help engagement include development of a shared vision, drawing on the traditions of particular groups of clinicians in informing integrated assessment policies, and appropriate IT systems to promote information sharing. Factors hindering engagement include national policy implementation, viewed as inimical to clinical practice and low involvement by service users/patients.

Reviewing such previously implemented polices around integration, particularly at the assessment stage, offers lessons to learn in terms of the factors that may help or hinder the achievement of integrated practice, particularly regarding current policies around clinical leadership.

One in 14 people over 65 years suffer from dementia in the UK. Over 25 per cent are receiving antipsychotics, which cause increases in mortality and cerebrovascular events. The need for a reduction and the use of alternative supportive strategies has been advocated. Risperidone at six‐week intervals is the only antipsychotic licensed for treatment with regular review. The majority of management occurs at primary care level and in care homes. The purpose of this paper is to investigate antipsychotic prescribing practices and patient review in these settings.

In total, two surveys comprising questions addressing prescribing practices were developed and distributed electronically to all GP practices and care homes in Coventry and Warwickshire, West Midlands, England.

The majority of GPs (75 per cent) reported only “occasional” discontinuation of antipsychotics due to concerns at reducing drugs on their own, expectations of regulation from secondary care and resistance from care home staff. Poor reduction levels were reported in care homes, attributing low numbers to reluctance among GPs. History of cardiovascular risk factors did not appear to influence withdrawal. Only 40 per cent of GP practices maintained sole use of risperidone. At least six‐monthly reviews were reported by 63 per cent of GPs and 64 per cent of care homes, with very few conducting reviews at least three‐monthly. The importance of non‐pharmacological alternatives was emphasized, yet access was limited and highly resource‐dependent.

This study reveals the perspectives of staff delivering healthcare for people with dementia and behavioural and psychological symptoms of dementia (BPSD). Potentially inappropriate antipsychotic principles were reported. A lack of communication and uncertainty of roles was evident. The development of understandable guidelines for healthcare workers and care home staff managing behavioural issues in patients with dementia is necessary.

This paper seeks to provide information on progress within one of the local authorities involved with the original Total Place pilot a year following the production of the final report.

Under a number of headings, the paper describes the progress being made in relation to the broader concepts described in the Total Place – Older People pilot report.

The paper reinforces the benefits of working closely and in partnership with older people and other public services, particularly the NHS.

The paper provides an example of how one local authority is working with partners on improving services and efficiency in outcomes for older people.

The National Institute of Mental Health England (NIMHE) appointed a Fellow in Ageing and Mental Health to take on a national leadership role for a three‐year period from 2003 to 2006. Starting from a position where the NIMHE website could only address older adult issues under social exclusion, a group of committed individuals in a range of organisations came together and a regional and national work programme in older people's mental health was developed. This paper offers reflections on the issues raised during the Fellowship in respect of older people's mental health services and this Fellowship model of leadership.