Purpose - The purpose of this paper is to illustrate the complexities involved in delivering seamless patient-centred care across organisational boundaries. There is particular focus on how working with an organisation outside the public sector challenges the ideology of those involved, thereby hindering progress. It will explore the challenges and solutions to delivering a service and discuss the key components of success. It will investigate the theory of partnership working and balance the importance of the emotional investment and understanding with leadership and project management. Design/methodology/approach - It explores the current "crisis" in NHS, along with political statements, emphasising its importance, but failing to address the issues faced by workers and agencies in the "outside" world. It will examine the concept of the "other" to explain the struggle required to gain a place at the table in discussing integration/service improvement. It will use experience in negotiating between a reasonably large care and nursing home provider and public sector bodies in Wales and consider the factors leading to a successful collaboration. Findings - The Social Services and Well-being (Wales) Act, 2014 makes it clear that integration is seen as a critical means to achieve better outcomes for people and whilst not contesting that principle, the paper shows that integration is often limited in thinking and action to "public sector" integration. Originality/value - There have been few attempts to explore the role and function of care and nursing home providers in service improvement from the provider's perspective. It will challenge the practice of commissioning, that gives all the power to the commissioner and explores the commissioners' accountability for their role in partnership work. It also offers hope for a different kind of relationship, based on mature conversations and mutual respect, along with a system of governance offering guarantees for sustainability.
