Shift Surrey at Surrey county council is aiming to redesign services radically through its innovation lab.
So the way to square the circle is to redesign services.
It may involve patients and doctors working together to redesign services, improve a hospital's performance or develop self-management programmes for chronic disease.
"They are really asking for the authority to redesign services that take advantage of the unique, and now pervasive, architecture of the Internet," he said.
Changing structures combined with reduced budgets have created new challenges for commissioners involved in improving and redesigning services – and involved many others in commissioning for the first time.
Commissioners should take the opportunity to redesign services, considering both the needs of patients and how services could be structured to ensure these are met.
"We are funding this because we think it should be the blueprint for how Barrow and Cumbria can redesign services," says Evans.
This will make the central bodies – and to a significant degree, Stevens personally – responsible for redesigning services in areas with sometimes decades of poor performance.
The team at Hants and PA recognised that to succeed they had to redesign services, be innovative in the way they identified people for the service, and provide credible evidence of the benefits.
To succeed in redesigning services using a combination of policy, IT, communication and customer service skills from the outset, government must challenge some of its traditional ways of working and strive for more pluralist thinking.
