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Commissioning is something you should do with a provider, not to a provider.
Both parties should help to shape the new service: both parties have obligations to the other: both parties are responsible for outcomes, patient experience and value for money.
True commissioning is collaborative, not competitive.
Or it should be.
At its heart is the word "mission" and that mission has not been articulated well enough by our politicians or leaders since the adoption of commissioning in the early 1990s.
Commissioning never got going because it was never understood or welcomed by most of the NHS. Powerful vested interests rang rings round the weaknesses in the system; the centre was deaf to anything but good news; "payment by results" did not do what it said on the tin, and "QIPP" lived up to its acronym!
Management consultants came and went with their fat fees, ineffective solutions and lack of accountability, just as clinical consultants did less than a century ago.
We have not just lost people in the latest reforms - we have lost visionaries. They were literally "disillusioned" because the vision, or dream, or mission, had gone.
Today the NHS is not dying. It is dead. It is on artificial life support while its organs (institutions, ideas and people) are harvested and sold. It cannot be re-assembled and resuscitated. It needs to be reincarnated.
So we do not need transformational leaders to conduct yet another set of reforms - we need transcendental leaders to change the whole philosophy. We need to put the mission back into commissioning.