The passage of the Health and Social Care Bill has created a plethora of new structures in England but no certainty that they can exercise enough power either on their own or with others to drive through improvements in service delivery, a breakfast seminar heard this week.

In the second of a series of King’s Fund breakfast meetings, on 17 July, participants chewed over the role of commissioning—for 20 years the vacant lot between the silos occupied by service purchasers and providers.

Neither Stephen Dorrell, chairman of the parliamentary select committee on health, nor Andrea Young, regional director designate for the south of England for the new NHS Commissioning Board, made any claims that commissioning had in the past really worked as intended. Too often, Dorrell said, it had been experienced as “something done to clinicians by managers, and so long as it feels like that, …