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i) It is deeply depressing to read that "everyone I’ve spoken to is at a loss to explain why GM’s performance has been so poor, given the progress that’s been made on integration and the transformation investment that’s gone in". ii) Unless a decade long retrospective forensic analysis of the root cause of progressive year on year increases in A&E attendance had been undertaken (prior to any targeted attempts to reverse a sub-regional and national trend) and unless such an analysis had clearly identified that failures of inter-partner 'integration' was the sole or a significant contributory cause of that trend, it is iii) simply the worst kind of naive & magical thinking to expect that enhanced integration would reverse this trend whose underlying causes are likely, inter alia, to include iv) demographic change/ageing, the impact of austerity and economic decline on deprived sub-populations of the vulnerable, NHS/LA/ Voluntary Sector workforce numbers and morale deterioration since v) the majority of these factors lie totally, or majoritively, outside the control of Devo Manc partners.