Since the original decision to keep the NHS organisationally distinct from the other aspects of the welfare state, improved collaboration between health and social care services has been a major policy objective. With the ‘hollowing out’ of the state and the emergence of a more ‘differentiated polity’ generally, and with the creation of internal markets within public sector services more specifically, the need for ‘cross-cutting’ solutions to enduring social problems became more acute. By the same token, however, the achievement of those solutions may be commensurately more difficult. On a practical level, public sector fragmentation increases the number and type of agencies involved and thus the potential for organisational or disciplinary dissonance in joint work. On a deeper level, there may be tensions between the exhortations to collaborate and the competitive ethos of the marketplace. The separation between politics and administration, moreover, and the growth of ‘intermediate agencies’ may make it less easy for the central state to provide effective overall coordination. As the 20th century drew to a close, there was a growing concern on the part of the international policy community about the discord between the precepts of new public managerialism (NPM) and the principles of good governance (World Development Report, 1997).

The search for ways to improve collaboration between the NHS and social care services has been most active in respect of community care, but has also characterised the development of services for children and their families. Particular pressures for greater collaboration in child protection resulted from a series of official inquiries highlighting poor liaison between different agencies and professional groups. Effective collaboration may be especially difficult to achieve in the child protection context, however, as a result of the sheer number of different professions and agencies involved. The NHS may experience particular problems in respect of collaborative work, given its complex organisational structure and its diverse professional groups.

The historical response of governments to the lack of collaboration has been to develop new mechanisms and procedures to underpin joint work. In child protection, these have ranged from the establishment of Area Review Committees (ARCs) (now the ACPCs), joint child abuse registers and interdisciplinary case conferences, to the detailed prescriptions of the Working together guidance and the incorporation of child protection work into wider national performance and assessment frameworks.