National governments have at their disposal a wide range of methods for realising policy intentions and for monitoring performance. These include policy guidelines and regulatory frameworks; standards and targets; and arrangements for audit and scrutiny. While governance arrangements of this kind are integral for ensuring accountability, the form they take is influenced by the approach adopted by the government in power to regulation and performance management. This affects the balance across regulatory and voluntary approaches, the extent to which legislation (including public health-related legislation) is adopted as an instrument of governance and the emphasis on selfassessment as opposed to centralised monitoring of organisations. As part of this, the landscape of standards and targets is liable to change, with shifting balances across central control of measurable targets and local flexibility, differences in the emphasis accorded to outcomes as opposed to process measures and varying recognition of partnership success as opposed to the success of single organisations. The transition, in 2010, from a Labour to a coalition government saw the deliberate dismantling of a complex and far-reaching system of governance arrangements, including those related to the NHS and local government. This affected the system of targets, incentives, monitoring and audit arrangements across the commissioning spectrum, including services for health improvement. Performance management of public services through a large number of explicit performance targets, was a characteristic feature of the former Labour government, sometimes described as a regime of ‘targets and terror’ (Bevan and Hood, 2006), although there was also a range of initiatives designed to support organisations in meeting targets. At the time of the study, improving health and narrowing the health gap were policy priorities, associated with directing resources towards disadvantaged groups and areas and reflected in a range of targets and performance management arrangements. These included the national targets for reducing inequalities, departmental public service agreements (PSAs), objectives in Tackling health inequalities: A programme for action (Department of Health, 2003a), the world class commissioning (WCC) assurance framework (Department of Health, 2008a, 2009a), and the ‘Vital Signs’ of the Annual Operating Framework for the NHS (Department of Health, 2008c). Reducing inequalities was also a mandatory indicator for targets agreed by local partnerships.