There are many people who are highly sceptical that full care and integration will ever be achieved, so great are the cultural and budgetary barriers, hence the reason why all eyes are now on the £6bn Greater Manchester integration programme.

The appointment of a seasoned ex-local authority chief and Department of Health mandarin in Jon Rouse to run it is an excellent start and sends out a clear message that this is truly a partnership between the NHS, central government and local authorities. Most importantly it signals that Whitehall is determined to make this work.