ABSTRACT
Commissioning is a relatively concept which has crept into common parlance in the NHS in England and Wales over years. Its origin and growing usage can be traced back to the NHS reforms of the late 1980s, which heralded the introduction of the internal market into the NHS. The widespread service problems resulting from the excessively local focus of much purchasing and commissioning led to a growth of interest in finding ways to address the problems of specialised services. A cancer unit should be named and the hospitals which it consists of should also be named. They should be part of only one unit and be subject to one cancer unit's appraisal. They may receive referrals from other cancer units in some circumstances. Cancer networks were expected to increase the involvement of managers. In many locations cancer networks had been predominantly clinical, with little support from or involvement of traditional management structures.
