Advice to conference exhibitors; you will fill your stand with grateful delegates if you provide some comfy seats for the exhausted to sit down. You may not convert them all into sales leads but you will win friends and we all know, these days, it's about customer relationship management. The comfy seat will bring you closer to a sale than a brochure ever will.

I don't know who designed the brooding monster that is the Excel conference centre, on the banks of the Thames, but they forgot about seats. The space is a masterpiece; column free, the ceiling is so high it creates its own climate. Thirty two thousand, plus, square meters of backbreaking, foot wearying, unforgiving flat floors where everything seems to be half a mile away and everything must be queued for. The saving grace; the loos are spotless.

I was there, last week, at the Commissioning extravaganza. Very good it was, too!  Fortunately I had access to the speaker's coral which turned out to be a day-centre for old-geezers (like me) who were queuing up to speak. Charming young people were on hand to get us cups of coffee and dainty sandwiches.  

Charles Alessi, old geezer and head honcho for the National Association of Primary Care agreed; all that was missing was a game of bingo. Mike Dixon of the Alliance, old geezer, arrived and complained he had nowhere to comb his hair. As he is the only one with any hair left, we were unsympathetic. 

The atmosphere was like a gentleman's club until Lady GaGa turned up, biffed us with her rucksack and told us all off. I'm not sure what we'd done to deserve it? I think she just has a thing about bossing old-geezers or she was warming up for her fearsome speech later in the day.

I'd trudged the stands, had some hilarious chats with the exhibitors and was ready for another sit-down. As Lady Gaga had closed our pop-up day centre I took refuge in one of the sessions. It was packed. We sat, hushed and mumbling for ages as an air of expectation enveloped the cavern. I couldn't figure out why until Mike Dixon appeared on the stage and gave a grovelling introduction to LaLite. No wonder he wanted to comb his hair!

I was stuck; leaving was out of the question so I just had to watch as LaLite bounced onto the stage, stripped off his jacket and began by telling us what a good job we were all doing. I don't think he knew I was there! LaLite has become skeletally thin.  His hair still sticks up and he has an odd gesticulating delivery; all elbows and fingers.  The stage was lit in a spooky Armani green; he looked like an extra in Michael Jackson's Thriller video.

He no longer says the NHS is coasting, neither that it is failing. Someone has put the Commonwealth Fund report on his desk. Now he has a new narrative. There's an election coming so he has to big-up the NHS and take the credit for saving it from its commodious, lazy past.

To be honest I wasn't paying much attention; I was thinking about buying some corn-plasters and queuing for a back-massage. My mind wandered; wondering how long the queue would be at the Costa bar or if Lady Gaga would let James Kingsland, old geezer (with hair), and me back into the day centre... when LaLite said something.

LaLite said 'commissioning is more important than inspection'. Yes, he did. He really said it, yesssss! At last he gets it! If you commission SMART your risks vanish. LaLite is starting to understand proper management is not found in political rhetoric. Management guru Peter Drucker is thought to have invented SMART, but actually it was the lesser known George Doran.  No matter.  What does matter is, for Commissioners, SMART spells contracting for Specific areas of improvement. Measurable quantifiable outcomes. Assignable; nailing who's responsible. Realistic; can it be achieved given available resources. Time-related; what's the window?

I was just getting over that shock when LaLite slipped in; he wants CCGs to become Accountable Care Organisations.  Yes, really, he did!

ACOs; unified providers tied to quality metrics, cost containment, coordinated and integrated that start with the patient and work backwards. Collaborative, cooperative and concerted. Focused on the small proportion of people who account for a high proportion of use and cost. Vertical integration; here we come. Yesssss!

Back at the day centre we sat in numbed silence... twice I had agreed with with LaLite.