Why 30 years of commissioning reforms have failed (HSJ, 29 April 2026)

Summary

NHS commissioning reforms repeatedly fail due to structural, financial and political barriers, raising doubts over whether latest changes can succeed.

Drawing on Nigel Edwards’ analysis, this HSJ article highlights recurring problems, including overambitious scope, chronic skill and capacity gaps, information and power imbalances in favour of providers, repeated loss of institutional memory through reorganisation, misplaced financial risk, and political resistance to service change.

While the new Strategic Commissioning Framework and the move to consolidated integrated care boards have sound principles, the author warns they will only succeed if there is genuine devolution to place level, clearer decision rights, a financial architecture that allows investment and savings to align, and an accepted, transparent approach to decommissioning services.