The first lesson was that producing a HImP was a huge task, with many other initiatives competing for resources.

We had to invent a new type of planning resource, create the capacity and find the skills we needed. This often meant switching senior staff to new tasks such as chairing an area HImP group or producing HImP documents.

Managing people's expectations was challenging. Everyone wanted their area of work included, and more people and organisations than we could cope with wanted to be more fully involved. Sometimes groups expected that a mention in the HImP meant getting money. We had to balance being inclusive with keeping the process manageable.

We also found that people were disappointed when they found that only the national priorities and a few local priorities were featured in a HImP. Much NHS and social services work did not feature, and neither did major areas such as sexual health.

Partnership arrangements

A positive aspect of the process was that it brought people from different organisations together.

Area HImP groups are now developing plans on their local priorities, and thinking through ways to develop the national priorities. We aim to set targets and indicators of progress which HImP partners can act on and monitor together.

We are reviewing our partnership arrangements, discussing what should succeed the joint consultative committee structure which is now being phased out across the country as part of national policy.

We are seeking to develop partnership boards in each local authority area, which will be inclusive of all parts of the NHS, the voluntary sector, service users and carers, and the public and their elected representatives.

PCGs, trusts and social services met each other and shared concerns. We encountered people who were extremely enthusiastic and helpful - for example, offering to chair HImP planning groups and to draft plans.

New partnerships also revealed the degree of fragmentation which needs to be overcome between different parts of the NHS and different directorates within local authorities.

Issues also arose about accountability, differences in priorities and agendas, and how to get partnerships to deliver. Our information bases were also different. We found the HA and local authorities often used different population statistics.

Managing the process

We wanted to ensure that we developed clear, measurable objectives which we could deliver, but we had insufficient time to go beyond setting out broad action plans. We used a variety of methods in area HImP groups to agree joint local priorities, which were successful given the time constraints. But these were not particularly rigorous and did not include as wide a range of partners as we would have liked.

We also need to find a way of meshing the service and financial framework process with the HImP, and a way to keep the HImP on course despite the pressures of reducing waiting lists and dealing with emergency admissions.

We found that there was often a tension between national and local priorities, with organisations not supporting, for example, extra resources for reducing waiting lists.

Social exclusion and inequalities

We found we needed to link the concepts of social exclusion and health inequality, and bring together all the initiatives which address these two major concerns. It is also important to develop enduring approaches, not merely to spawn one short-term initiative after another.