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Hirschman contrasts exit and voice as 'recuperation' mechanisms for making organisations responsive to users. However, the emergence of health-care quasi-markets and of network governance structures since Hirschman necessitate revising his theory, for they complicate the relationships between governance structures and recuperation mechanisms. Using a case study of nine primary care trusts (PCTs), this paper analyses the recuperation mechanisms, governance structures and relations between them in primary care in England. User voice can be exercised through dedicated networks besides hierarchies. As well as the 'user exit' described by Hirschman, two new 'exit' mechanisms now exist in quasi-markets. Commissioner exit occurs when a third-party payer stops using a given provider. Professional proxy exit occurs when a general practitioner (GP) fund-holder (or analogous budget-holder) behaves similarly. Neither exit mechanism requires the existence of mechanisms for user exit from healthcare purchasers, provided strong voice mechanisms exist instead to make commissioners responsive to users' demands. Establishing such voice mechanisms is not straightforward, however, as the experience of English PCTs illustrates.

Partnership working has become a central feature of British social welfare policy since 1997. Although this development is applicable to all areas of public welfare, nowhere is it more evident than in the planning and provision of care that overlaps health and social services. The literature survey described in the present paper focused on research examining the impact of partnership working in these areas to assess the evidence concerning its effects and to investigate how partnership 'success' is conceptualised. The literature conceptualised the success of partnerships in two main ways: (1) process issues, such as how well the partners work together in addressing joint aims and the long-term sustainability of the partnership; and (2) outcome issues, including changes in service delivery, and subsequent effects on the health or well-being of service users. The authors found that research into partnerships has centred heavily on process issues, while much less emphasis has been given to outcome success. If social welfare policy is to be more concerned with improving service delivery and user outcomes than with the internal mechanics of administrative structures and decision-making, this is a knowledge gap that urgently needs to be filled.