In the year 2000 the option of a single organisation leading on the commissioning and/or delivery of health and social care services was proposed in England in the form of care trusts. Overall the lesson from care trusts appears to be that structure can provide additional benefits but only if there is a history of joint working and trust, a clear vision and the active engagement of prospective users, local community and staff. Furthermore their experiences underline that the historic differences and tensions between health and social care remain, and that integrating with one service can lead to a greater distance from another. These are important lessons for Health & Well-being Boards to build on as the English system moves to the new world of GP led commissioning, a national public health organisation and community services being delivered by a range of organisational forms
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