Against this background, both research and recent practical experience suggest one thing that probably will not work, and four things that might. Often, debates about integrating care can focus on integrating separate organisations, and the English NHS in particular is reorganised on a regular basis. While such structural ‘solutions’ look dramatic and bold, the evidence around mergers and acquisitions (in both public and private sectors) is that they rarely achieve stated objectives, often fail to save money and tend to reduce morale, productivity and positive service developments (often for some 18 months to two years after the initial change – if it is managed well). Moreover, the evidence from the NHS is that hospital mergers tend not to take place for the reasons stated in the consultation document – but in response to local/national politics, to save money (even though they tend not to) and to get rid of management teams that are deemed to be failing. None of this is to say that changing structures cannot be part of a broader solution; it is just that it often isn’t – and it certainly should not be the first place to start.