The government has spelled out its long-awaited move from central, top-down targets to local flexibility in the public service agreements that accompanied last week's comprehensive spending review.

The Department of Health will lead on two of the 30 new PSAs and play a role in several others. Although existing targets remain, including the 18-week referral-to-treatment target, there are very few new targets. Instead, there is a commitment to developing a new outcomes and accountability framework.

The two relevant PSAs - promoting health and well-being for all and ensuring better care for all - say: 'Delivery and continuous improvement in a reformed system requires an approach to performance that goes beyond top-down targets to support a more devolved, innovative system that encourages performance improvement across the range of services.'

Primary care trusts will be able to set 'stretch' targets decided locally and will have their performance measured in a 'rating card' to be developed by the new regulator.

Although the change in direction from top-down to locally driven targets has been signalled for some time in ministerial speeches, this is the first time it has been set out in policy.

NHS Alliance chief executive Mike Sobanja added: 'The more local flexibility, the better. We are advocates of stretch targets that are sensitive to individual communities' needs.'

PCT chief executives were also pleased with the approach. East Lancashire PCT chief executive David Peat said: 'This reflects what we are trying to do locally. It's an approach we welcome, provided they are truly local and truly stretching.'

Tameside and Glossop PCT chief executive Tim Riley said: 'The PSAs really will help us to build on more personalised care for patients and wider communities and integrate our approach with local authorities and the voluntary sector.'

But shadow health secretary Andrew Lansley said talk of local targets was rhetoric while the 18-week target remained. 'It is completely inconsistent with the government's expressed new philosophy about targets.'

What's new, what stays, what changes: a snapshot

  • New: Increase percentage of women accessing maternity services by 12 weeks of pregnancy.

  • New: More people with anxiety and depression to be offered talking therapies.

  • New: More people with long-term conditions to be supported at home.

  • Stays: Reduce mortality rate and inequalities gap for cancer, heart disease and stroke.

  • Stays: Reduce adult smoking rates, teenage pregnancies and mortality rate from suicide.

  • Changes: Halting the rise in childhood obesity becomes reducing the rate to 2000 levels by 2020.

  • Changes: 18-week referral-to-treatment time now includes patients who do not need to be admitted to a hospital as well as those who do.

  • Changes: Tackling MRSA becomes a PSA instead of a high priority.