To maximise the potential of Health Boards as local planners, purchasers and providers the centre may have to step back in and play a more supportive - and prescriptive - role. With the introduction of the Integrated Medium Tenn Plans Wales has taken a step in the right direction, but more work is needed to get the balance between local freedom, innovation and sensitivity to population needs, and core standards that should be centrally driven, right. Similarly, the introduction of an Escalation and Integration Framework in 2014 seems to be an appropriate development. More can be done to set, and publicise, core minimum expectations of all local Health Boards.