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The Richmond Group were invited by the Local Government Association to contribute to a collection of essays reflecting on the decision to further devolve health and care commissioning and provision to Manchester local authorities. Charlotte Augst (page 24/25) argues that whilst moves to greater integration are welcome, structural reorganisations alone rarely deliver the transformational change of patient experience and outcomes that are required. “Far more important than structural redesign are the relationships between people: Can information about service users flow between all those who need to know? Does everyone have access to the necessary expertise to make decisions that keep people supported? Is everyone aware of what the priorities and wishes of the service user are?”