Under NHS England's new five-year plan our sustainability and transformation programme is to be organised by COBWeB (Commissioning for Oxfordshire, Buckinghamshire and Western Berkshire). This organisation will be headed by David Smith, continuing and current chief executive of Oxfordshire CCG. What level of public and patient participation, local authority engagement and collaboration there will be over this unwieldy and unnatural area remains to be seen. There is a long history of mismanagement of Reading's facilities by county-level authorities, and Oxford-based management of the AAA screening programme in Reading has been far from inspiring. Let us hope that David Smith will show that this is not inevitable.