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Members of the public should really know what both commissioners and providers measure to determine performance and quality.Many would be shocked and dismayed how many national, regional, local, internal KPIs exist which aren't grounded nor aligned to commissioner priorities nor reported properly. That needs to change and simplify. It is absurd how many change and reconfiguration programmes exist and are implemented without any evaluation or benefits realisation or ROI analysis reported. Perhaps because they are poorly thought through or shifting problems elsewhere. No other business could operate with such an incredible amount of waste in the system, extremely poor processes, and the appallingly neglectful approach to reducing this waste where it matters. No business would stay afloat unless the budget balanced and decisions were made by people who knew what they were doing. No amount of reconfiguration or a more strategic approach will make much difference if the basic housekeeping of a complex organisation is not clear, simple, and functional. Your guitar will sound rubbish if it is out of tune irrespective if you're an expert and have six strings.

I don't usually comment on here, but I fear the NHS is becoming more dysfunctional every day until someone steps up (or down). There are plenty of leaders within the service/system with the skills to get our NHS organised and coherent - But they are getting fed up and some have already taken money and gone. Culture is a major problem too - the more senior and experienced should learn to listen. There are very few 'teachers' who develop talent and mentor junior clinicians and managers. Until all these things are considered important enough to do something positive about them, we will only continue going in circles and maintaining services for patients, rather than what we should do which is develop simple, smart and polished ones that positively impact on patient care and our society.