Piloting the NHS towards quality requires robust regulation and inspection, and the DH has already set up overlapping organisations to provide this, presumably with a thinly spread budget. But if Lord Darzi's plan is to be accomplished, it will require action rather than rhetoric, and action requires funding.

Until recently, "quality island" was a nice place to be heading, generally agreed on with warm words, conveniently light on detail, poor on connections, but most of all not too crowded. It was a luxury destination, but the island has just become mainstream.

Quality has many attractions in healthcare, not least to patients in preventing ill-health or managing problems effectively when they arise. For the more initiated, the correlations between quality, safety and case volumes are well known. It is not a great leap to then map case mix to cost efficiency by site and physician or to look at outcomes variation or inequality. Quality has come a long way from early clinical governance approaches and the quality and outcomes framework.

The healthcare beach has been packed with quality ideas this summer, prompted by the final report of Lord Darzi's next stage review. The Conservatives have set out ideas to commission against outcomes. The National Institute for Health and Clinical Excellence will be setting independent quality standards. Quality accounts will be published by all health providers, with new easy-access information portals and a rejuvenated NHS Choices website. Hospital payments will start to reflect patient experience and new best practice tariffs will evolve. Plans to strengthen the clinical excellence awards scheme and create a plethora of new medical director posts have also been announced.

All this for£550m - an absolute bargain - if you take parliamentary questions at face value.

No argument

Like motherhood and apple pie, it is difficult to disagree with most of these ideas. The reality often underpins the rhetoric in policy documents. What is said is not the problem - what isn't often is. Think back to the Health and Social Care Bill, which defines the Care Quality Commission's functions in assuring safety and quality, assessing the performance of commissioners and providers, monitoring the operation of the Mental Health Act and ensuring that regulation and inspection activity is co-ordinated and managed.

At the same time as creating a commission with fantastic new enforcement powers, the Department of Health seems to have set up duplicating initiatives such as a new national quality board, quality accounts and quality oversight at primary care trust and strategic health authority level as part of commissioning.

Perhaps there's nothing wrong with this, but it does predetermine what kind of regulation you have - the overlapping, skinny budget variety. Who wouldn't have liked to have been a fly on the wall when the NHS chief executive mentioned these new helpful initiatives to the incoming commission chair?

A popular quote from Mark Twain springs to mind: "There are basically two types of people. People who accomplish things and people who claim to have accomplished things. The first group is less crowded."