For the first time in many years it is now possible to have an open and honest discussion about what John Stewart calls the ‘wicked issues’ in government. In health it is possible to acknowledge the vital importance of poverty, employment and social exclusion. The Green Paper, Our healthier nation, reminds us of all the factors that affect health.

If we are to improve health the NHS must work with everyone who can influence these factors – individuals, communities, voluntary groups, district and county councils, the Benefit Agency, schools and colleges, employers, the police and probation service, and those responsible for transport and economic development.

The NHS will not improve health by itself. David Wilkinson and Elaine Appelbee speak directly to all those concerned to tackle the ‘wicked issues’. They challenge us to deliver joined up action on the ground. In order to do this we need “to change the culture of both service delivery and of citizen engagement with it.” The greatest challenge is at local level. Powerful policies and frameworks are now in place – we have to find a way to make them real where it matters.

We must find the means to achieve “grounded change” and to do this we need to discover new ways to engage “those who are most affected by the consequences. People must be engaged in rebuilding their own quality of life in partnership with professionals, not in the latest manifestation of disempowered dependency.”

It is not enough to make good use of ‘special’ funding at the margins of public resources. David and Elaine focus us back on the vast resources already available to the public services at local level: “sustainable improvement is dependent upon the integration and better application of mainstream spending.” This powerful book challenges us to establish public enterprise, to discover “innovation and entrepreneurship … which requires moral courage.”

Leadership of the highest calibre is needed to achieve joined up action on the ground. David Wilkinson and Elaine Appelbee leave us in no doubt about what is required. To all those who aspire to leadership in local government, health, statutory and voluntary agencies and in the community itself, powerful advice is offered.