We have been talking about health and care mergers for months, years, even decades and still little has occurred, other than localised arrangements while the Better Care Fund still only represents 5% of the total combined health and care budget for England.

But the Manchester health and care deal is a huge step forward. Yes, at the moment it is just a piece of paper, the memorandum of understanding, and the process of actually implementing it could take years, but at last there is indication of bold vision among ministers.

The MoU, signed today at Manchester Town Hall by the ten Greater Manchester councils, 12 clinical commissioning groups, 15 NHS providers, NHS England, George Osborne and Jeremy Hunt, ‘sets out the ambition for full devolution of funding and decision-making for health and social care within Greater Manchester.'