A year on from the launch of Lord Darzi’s next stage review, both the progress and the huge distance still to travel are clear.

The review has succeeded politically, taking the NHS off the electorate’s list of complaints about the government.

Inside the service it has provided a renewed opportunity to build a common purpose between managers and clinicians, replacing the alienating language of accountancy terms such as tariff and payment by results with a lexicon which can unify and motivate - quality, safety and innovation. Lord Darzi is right to claim this as a significant achievement.

Progress on innovation has been slow, but even that is now gaining traction.

The review has also gone some way to pushing power down from the centre. Instead of being a national review to which trusts and regions responded, it was led regionally and locally and responded to nationally. So for once the Department of Health did its best to be the cart rather than the horse. Devolution still has a long way to go, but the review made progress.

Within local organisations the successes to date serve to highlight how much remains to be done. The mood music has changed, progress in improving care has been made, but there is a long way to go. It was with good reason that the government pitched the review as the start of a 10-year journey.

Now it is being recast to reflect the demands of the recession. The cold term “productivity” has been squeezed in alongside its warmer siblings quality, safety and innovation. The regional Darzi plans must deliver savings.

The original visions were strong on pictures of happy, fruit-munching children jogging through the local park but weak on costings and detail.

Now NHS chief executive David Nicholson has ordered a reality check, with strategic health authorities reviewing their plans to determine what they can really afford.

The focus on quality, safety and innovation is immutable. The economic climate just makes it a great deal tougher to achieve.

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