change can be difficult in an organisation the size of the nhs, particularly at a time of crisis, but the doctors and nurses we have met believe building more services around patients at home is betterfor them, better for staff, and inevitable. all change gets resisted and it is a complex business to understand how you can innovate and change in a stressed environment. but i think of the matter is where that innovation is most needed. how we want our health care to be, personalised, responsive, and still being able to make a difference, not just of health care level, but also at a thriving and quality level. to achieve that, solving deep—rooted staffing shortages will be key. if that doesn't happen, the danger is the health and care system continues to lurch from crisis to crisis.