Recent surveys and analysis of the funding situation for the NHS and local government are disheartening to read. The NHS and local government face enormous challenges just to manage current demand, never mind meeting fast-rising future demand. The new models of care could provide an important way to overcome these challenges by providing delivery models that enable more people to be treated and cared for within their homes and communities rather than in expensive acute care settings.

But change on this scale cannot be ‘done to’ local communities – it needs to be negotiated with communities’ close involvement through co-production. And change also cannot be dictated through old-fashioned linear planning; we need creative approaches to problem-solving – which include a fair degree of trial and error and experimentation – to arrive at solutions. Constructive conversations, taking place between service providers and service users and communities, can help broker these solutions, enabling hard-pressed service leaders to use the expertise, assets and experience of citizens to help guide their decision making.