The NHS continues to change to improve clinical and public health outcomes despite post-Brexit policy paralysis and the lack of the usual biennial health legislation. At the same time, the latest wave of devolution – the advent of Metro Mayors, nine of which now serve more than 20 million people in England – has quietly embedded itself into the body politic.

These two trends have come together most significantly in Greater Manchester but ‘health devolution' is by no means confined to one part of the country. The NHS Long Term Plan envisages the NHS silo of power and money in England being broken down into 44 Integrated Care System bodies with new geographical footprints. It is a fundamentally new delegation from the national to the local in the system. And it is one that will go even further as NHSE is then committed to supporting ‘local approaches to blending health and social care budgets where councils and CCGs agree this makes sense'.