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Nothing new here at all! The difficulties of whole system thinking in a complex system like health/social care are well known and have been studied and written about ad nauseam. We can improve performance by focusing on interdependencies within a part of the system but optimising performance at multiple levels across other parts of the system requires multiple interventions, the right incentives / penalties, targets that aren't incompatible and real willpower to change things. We should also try harder not to lose the knowledge from past efforts at whole system change in this area, such as the Unscheduled Care Collaborative Programme in Scotland, which now seem to have been forgotten.