This White Paper sets out the government's agenda for a radical and sustained shift in the way in which health and social care services are delivered. The paper's starting point that everyone in society has a positive contribution to make and should have a right to control their own gives emphasis to the role of commissioning, and sets new expectations for health and social care commissioners to allow greater control and determination to those who use and rely on services. Overall, it describes the following four key goals or outcome objectives it wishes to see delivered:

• Better prevention services with early intervention.
• More choice and a louder voice.
• Reduced inequalities and improved access to locally based services.
• Increased support for people with long-term needs.

By:

• Shifting resources into prevention.
• Establishing more care outside hospital and in the home.
• Encouraging innovation.
• Allowing different providers to compete for services.
• Pushing forward the implementation of practice based commissioning and payment by results.

The paper calls for a more person-centred approach to the commissioning and purchasing of services; commissioners will have a responsibility to ensure appropriate provision is available for users of Direct Payments and Individual Budgets, and not just those for whom agencies purchase direct provision. In forecasting future demand, commissioning strategies will need to take account of the service models that users of Direct Payments and Individual Budgets might wish to use. In purchasing and contracting for services, authorities will need to consider how far their service specification offers protection for independent purchasers of those services who are using their Direct Payments or Individual Budgets.

Central to the delivery of the government's agenda is the commissioning of community services via stronger joint commissioning between PCTs and local government, and improved joint working between the NHS, local government and the voluntary sector. This will call for greater alignment of funding arrangements, planning cycles within an outcome based performance framework and joint performance assessment and inspection regimes. Local authorities are expected to take a key strategic and leadership role and to work in an inclusive way with key partners to provide integrated services to meet the needs of a diverse community.

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