Management and leadership are a lot about clarifying a desired future and then helping people and organisations to get there.

"Clarity" and "help" are not used often enough to describe NHS management. However, "world class commissioning" does not clarify or help. It is likely to become "wc" commissioning and be part of a "wc" credibility gap, argues Paul Knutson

The NHS is apparently 17th out of 27 in Europe. So "world class" lacks credibility. I suggest that our health service goal should be to reach the upper quartile for Europe by 2018. And we should use European league tables to provide useful feedback on how we're doing.

We have many improvements and successes in the NHS. But other countries are also working hard to improve.

The commissioning (or contracting) of services is an important part and not easy. Health and social services are so complex that I don't believe anyone can stand up and say they know how to do it. We, and many other countries, are doing what we can to learn how to do it.

To get the best services, you need to develop the best suppliers and better customers. You need to develop supplier capability and alternatives and to develop customer expectations, attitudes and skills. This takes long-term persistence. We are not even sure there won't be another large reorganisation in two to three years.

To achieve the upper quartile in Europe would be a huge transformation.

Paul Knutson is managing director of Paul Knutson Ltd.