Integrated care must start with a new single national framework

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Former NHS England boss David Nicholson famously described Andrew Lansley’s NHS shake-up as 'so big you could probably see it from space'.

Five years on the consequences are much more down to earth, with an organisational landscape so complex that, rather like the peace of God, it passeth all understanding.

The imperative to integrate care around the needs of an ageing population with a mixture of conditions and needs that defy service boundaries has never been greater.

Yet, responsibilities for commissioning different pieces of the jigsaw has never been more fragmented and are now scattered across nearly 400 separate organisations.

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