The health White Paper was both expected, and unexpected. Expected because the Health and Social Care Act 2012 no longer bears any real relationship to how local health services are managed and because the move to put integrated care systems (ICSs) on a statutory footing always seemed a case of when, not if. But unexpected because it comes when a pandemic continues in full force, and Government's extremely ambitious timetable sees its provisions coming into effect, on the ground, next spring.

Both factors perhaps account for the lack of wide discussion of the White Paper and its contents. It fizzled in the national press for a day or two and was then lost amidst the continued drumbeat of COVID updates. But it would be wrong to miss this opportunity to speak out about it, as it involves a profound shift in scope and emphasis for the NHS at local and national level.