Learning from doing: implications of the Barking and Dagenham experience for integrating health and social care

Local government and the NHS in Barking and Dagenham embarked on a bold initiative in 2001 to integrate health and social care management structures. Although it was not sustained, this local experience is an important source of learning as the search for improved partnership working enters yet another new phase. In particular, it demonstrates that the route to better outcomes depends on managing not only the tension between structure and culture, but also that between national targets and local discretion in services based on fundamentally different principles of governance: central management and local accountability.