Last November, commenting on the first Darzi report, I pointed out that only a crusade for nursing and a focus on team leaders would improve patient experience.

Earlier this year I talked about the need for treatment and care to be delivered by competent and knowledgeable professionals confident in their role and proud of their traditions, emphasising that nowhere is this more true than in nursing and that nursing is the essence of care.

Interim Darzi is now with us and the regional plans are rolling off the shelves. There is no reference to nursing in the interim report and it will be interesting to see how many, if any, of the regional reports give it a mention. Let us hope the final report tells us how the issues described in the first report are to be tackled and acknowledges the vital part that nursing has to play.

With the publication of the latest patient survey by the Healthcare Commission, now is the time to return to the subject. There is much that is encouraging, including the findings that 42 per cent of patients described their care as excellent, 74 per cent of patients have trust and confidence in nurses and 78 per cent were always treated with dignity and respect.

However, there are also three causes of concern. First, the wide variation in performance. In the "worst" places, more than a third of patients were not always treated with dignity and respect and 42 per cent did not get enough help to eat their meals. Second, some of the indicators are getting worse. For example, the number of patients who think there are enough nurses and that patients are involved in decisions has gone down and the percentages of patients who thought nurses sometimes talked about them as if they were not there and who experienced noise at night have gone up.

Third, the areas of most concern are all issues that can only be improved by better nursing. How else are we to tackle arrangements for discharge, involvement in decisions, cleanliness, response to call buttons and help with food? None of these patient experiences is likely to be affected by reconfiguring services. They will only respond to a dedicated focus on nursing as the essence of care.

There are encouraging signs, including the Dignified Revolution campaign in Wales and the work of the Burdett Trust and the King's Fund, with nurse executives and their boards recently advertised in HSJ. However, much more is needed.

We need a debate at all levels, involving patients, carers, nurses, nurse educators, students in nurse training and applicants for nursing programmes, doctors and all frontline professions including social care and every senior forum in the NHS. We need to understand how nurses feel about their work and the barriers they face. This is both urgent and important - nursing is the essence of care.