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All this completely misses the point...stacking deck chairs?....Joint commissioning has been around for ages, as has pooled budgets...have they driven up standards of care? better integration of care? or better care outcomes? Shifting the money round the system will do very little unless you change the culture of leadership, stopping the emphasis of organisational priorities before system priorities , and enable staff, clinicians, carers to make decisions free of buracracy and fear...none of this needs a debate about who holds the money, its just too easier an excuse not to do the right thing.