Lord Darzi's review of the NHS finally became a reality this week with the publication of the first two regional plans spelling out what the process means for patients.
Key themes to emerge from NHS Yorkshire and the Humber and NHS East of England's reports include a focus on tackling health inequalities, reducing waiting times and safeguarding popular services. Seven further strategic health authority reports are due in the next three weeks, culminating in Lord Darzi's final report, expected on 30 June.
The documents appeared as it emerged that NHS London would be pushing ahead with its controversial polyclinics.
As revealed in HSJ last week, the framework document published by Lord Darzi on Friday provides best practice on implementing reform, and highlights five key principles on which primary care trusts will be instructed to focus when delivering change. These are that change should benefit patients, that it will be clinically driven, locally led, involve patients, carers and the public and that existing services will not be withdrawn before better services are available to patients.
NHS chief executive David Nicholson praised the SHAs' local vision documents, saying the work was evidence that the service was "on the right page". He said: "If you'd asked SHAs to do similar sorts of work three or four years ago, you'd have had documents focused around the technicality of change. What you can see now is that quality and improving patient care is central to their mission."
He told HSJ the drive towards locally determined services would not result in the wholesale removal of central plans. "When you go to decentralise things, sometimes you have to centralise things at the same time," he said. "There will always be in a tax-based system a view from government about what they want," he added.
Partnership between clinicians and patients would be crucial to driving change, he stressed, adding: "The key thing is to get the rest of us to support and enable that to happen."
Responding to criticism that the proposal to open new services before closing old ones would inflate costs, he said the NHS surplus would be used to provide "headroom" to cover the expense.
He said: "The NHS should be creating a surplus every year... It does give the opportunity for us to deliver double running."
Reaction to Lord Darzi's framework was mixed. Simon Wood, programme director for service reconfiguration at NHS East of England, raised concerns over what would happen to staff where a service was transferred or closed.
He said: "We want to be able to give those staff the opportunity to transfer across and develop the new service rather than saying 'terribly sorry, you are providing an old-style service and you are not going to have the opportunity of moving across'."
Heywood, Middleton and Rochdale PCT chief executive Trevor Purt warned that local mediation - also proposed in the review - might not work where local authority overview and scrutiny committees were not satisfied with proposals.
And London School of Economics professor of social policy Julian Le Grand said: "What happens if [the new service] doesn't demonstrate what experimenters would like it to demonstrate? Are we then stuck with two services that aren't working very well?"
NHS Confederation deputy policy director Jo Webber admitted that the best practice processes outlined by the Department of Health last week might be more time consuming. But she added: "If it takes a bit longer and the consultation needs to be broader but what you get are services that deliver for patients, then you have to say that is what you would want out of the system."
Implementing Our NHS, Our Future is in London on 8 July.