This is the third in a series of reports published for the London Commission by the King's Fund. It makes the case for an integrated approach to health care in the capital. Currently, although health care involves a set of discrete activities which interact with each other across primary, secondary and specialist care, it is rarely viewed as a system. Primary care, community services, hospitals and continuing care are seen separately. Education, training and research add a layer of complexity, often functioning independently. The report makes the case for all aspects of service delivery being seen together, as well as education, training and research, to permit the impact of changes within the system to be better understood and managed. The report also contains a case study of emergency care in London.