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Dave West

Dave West

Oct 23, 2026

9:35
Dave, I think, what are your thoughts on how realistic this vision of strategic commissioning is? Is it now kind of just dead in the water? Because I guess lots of people in ICB land are quite keen to get into that.
9:50
They are at least they say they are and they've not had much of a choice, have they? And clearly the how it's been done has been nobody's really a fan of the how the cutting 50% and the kind of slow and painful way that's been drawn out.
10:09
But yeah, there are some people who believe in commissioning and i think that's sort of different there's kind of different camps around that i mean some people believe in commissioning i you know we do need um we do need um relatively sort of powerful kind of actors and sort of gritting the oyster to hold providers to account or they will um act in sort of self-preserving ways and um and not modernize and develop services in the sort of patient population centered way.
10:46
They may, you know, they sort of kind of, however, intentionally or otherwise becomes self-interested kind of the way that the reasons that commissioning was introduced to the NHS in the first place.
10:58
So there is belief in that.
10:59
And among some people in in commissioning.
11:04
And then there's a kind of the way that Jim Mackey, the NHS England chief executive, sort of talked about it when this was first sprung in spring 2000 and 25 was more like, look, we need that kind of contracting discipline was similar to that.

10 MINS LATER

21:12
I'm curious, thinking with your historical hat on, how does this compare to the previous experience?
15:53
with AI and empathy and empathy typically being the product owner's superpower, why can't AI replicate that from your perspective?
16:03
So I don't know if it can honestly, Jay, but what you said was really interesting.
16:09
When you start with AI, and we wrote a paper on this called Onboarding Your AI Teammate, which actually got a lot of pushback because AI aren't human.
16:21
We got a lot of things like that on social media.
16:25
But what you said, I think, Jay, really hit it on the head.
16:28
You expect AI to be super able from day one, and it doesn't have that context, right? It doesn't have that experience.
16:38
It doesn't have that knowledge that you've accumulated over five years, 10 years, all those social cues from those meetings with stakeholders.
21:41
Across that spectrum, what are some of the key standout points on that process for you as to some of the real-life practical ways you're seeing product owners and professionals use AI to either reduce that cognitive load, which, as you say, can also increase the cognitive load if it's getting too noisy, but also increase the value of delivery?
13:54
when we have Grogu at home? [laughs]
13:56
I, I would say that in all likelihood The Mandalorian is, is the benchmark of Star Wars success in the Disney era.
14:05
Uh, but that ...
14:08
And, and, and this is just, uh, well, I mean, success, you know, you were, Ryan, you were kinda talking about this a little bit.
14:17
Uh, I'm talking about corporate success, not creative success.
14:21
Uh, because creative success is absolutely meaningless in the year of our Lord 2026.
14:26
Corporate success, which is money, is the only thing that matters at all.

49 MINS LATER

63:57
[laughs]

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