About 20 months ago, after spending the bulk of my career in and around local government, I became designate chair of one of the new Integrated Care Boards and co-chair of an Integrated Care System (ICS). I have been operating in those substantive roles since we went live just over a year ago.

Many of my local government friends have asked me for my reflections in this new environment – and yes, there are undoubtedly moments when different histories, cultures, finance regimes and incentives collide and the sense of distance can feel significant.