The question of regional change, whether to cooperate more closely, even to integrate or not, has been put fairly and squarely on the regional agenda. The focus of this paper will not be so much on past or present trends, and what analyses of them might point to for the future, but rather on some of the practicalities of the present situation, some of the issues which will need to be faced if the region is to move forward regionally, and finally what some of the appropriate steps might be if the region is indeed to move forward.