Ham’s dissection of the problems of NHS commissioning is welcome to me as it shows I am not the lone voice crying in the wilderness that I feared I was.1 2

The current system of commissioning has lost touch with the reality of patient care. Commissioners have become obsessed with saving money and have started playing games to achieve this. Secondary care services are (largely) paid for through the payment by results (PbR) tariff, but increasingly we are seeing attempts …