The intriguing evolution of health policy in recent years has implications for all parts of the health system. With the UK falling behind most high-income countries on many measures of child health and growing evidence of a worrying health gap between UK children in deprived and affluent areas, paediatricians and others working in child health will want to remain abreast of the broader policy backdrop even where child health has not been privileged in policymaking. While the 2012 Health and Social Care Act reinforced the fragmentation of the service through multiple providers in competition with one another, subsequent policy promises local collaboration and joint working. This article traces this evolution and asks what it means.