Re-inventing a Long Term Dream: Do we need new systems to deliver “working together” We run a huge risk of repeating the mistakes of the policy 10 (PPM ?70) years ago, thinking that integration is solved just by fiddling with organizational form options” M. Winn 21.5.2018 I have had a career long passion in delivering services across sector boundaries as geriatric service lead of hospital and community health facilities, running the Institute’s Excellent Care Award, participating in the development of Stroke Illness pathways , and as a former chair of joint planning in Birmingham. My purpose with this publication is to seek examples of Good Practice, building on our experience from the “Excellent Care Award” to inform the work now being done under the new national drive to promote integration in commissioning and in delivering health and social care. The driver for this strategy is the long-standing perception that underfunded fragmented poorly delivered services can be reorganized to provide cost effective services with the person in need at the centre of the change required. The World Health Organisation (WHO) and NHS England (NHSE) see the patient/citizen as the pivot round which service configuration should be structured. But most service planning is initiated centrally and in the recent Sustainability Transformation Partnerships (STPs now becoming Integrated Care Systems (ICS)) the service user seems the last group involved in planning and driving service change. NHS clinical commissioning groups (CCGs) do have a requirement to consult their populations and some are doing this well but many are too small and lack the skills to deliver.