The Health and Social Care Act comes into force in April 2013. It changes the organisation of the health service and accelerates the integration of health and social care. New relationships between primary and secondary healthcare will develop and the culture of clinical and cost effectiveness will expand into social care; work on children in public care is in the vanguard of this change. However, this is not an organisational change designed for children and there are considerable anxieties about how it will impact on the delivery of health care. The issues for children in public care need to stay high on the national agenda and in local fora. (Contains 1 figure.)