At the end of the Hollywood film The Martian, having survived being left behind for 561 days on Mars, Matt Damon explains to new cadets that space is filled with chance, circumstance and bad luck. To survive: ‘You simply begin.

Solve one problem. Then the next one, then the next. You solve enough problems - and you get to come home.’ That is the story of working towards health care transformation in Britain.
Devolution is the vehicle to deliver us home. Elsewhere this might not be true. In Britain we have a centralised state and a centralised NHS, forming an environment in which the components of a modern health and care system struggle to flourish.