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"'Commissioning' has no clothes. As a slavishly lauded concept it should stand and look magnificent but really what has ever changed? "

I agree with my Anon colleague. Since the early 90s, this ridiculous overblown system has sucked cash from patient services through pretend markets and kept a generation of people with dubious or irrelevant skills in fat salaries. These individuals have mostly escaped accountability through frequent reorganisations, which no longer pretend to have any HEALTH related purpose.

Just consider the opportunity costs of this foolishness!

It'll be a brave economist who starts to count the costs of this in public money, let alone public health.