Lord Darzi's next stage review focuses on the importance of healthcare delivery, but at the expense of the details. Are local authorities up to the challenge of meeting the review's grand vision?

Lord Darzi's review has received a lot of column space over the last month, and rightly so. It is an important and influential piece of work. The review focuses on those important elements of healthcare delivery - quality and patient experience - that some would say have been lacking in recent years as we have been driven to focus on expansion, building capacity and meeting targets. Investment and building capacity have been important elements, but quantity does not always equate to quality or a responsive service.

Lord Darzi's review now seems to be bringing us back to focus on some of the NHS's founding principles - quality care for all, free at the point of need. However, as we have discovered over the last 60 years, this is not always easy to achieve.

The devil, as always, is in the detail, and the detail seems to be missing in this review. It is being left to local NHS communities to determine how it will be implemented. Perhaps this will ensure that services will be truly responsive to local needs, led by local clinicians and moving away from centrally driven targets and directives. But there is also the danger that this may make it hard to evaluate and balance the effectiveness and quality of potentially variable programmes of care in different areas.

Clinical leadership

Another important initiative in Lord Darzi's report is encouraging and promoting clinical leadership and engagement. While this is important, we must not forget that to effectively run and deliver this next stage of NHS reform, we need a firm partnership and understanding between clinicians and managers. Past experience shows us that neither one can effectively run the NHS in isolation.

But who will these clinical leaders be? What do Lord Darzi and everyone else mean and understand by clinical leadership and engagement? Is this just about doctors, the elder statesmen of clinical leadership, or does Lord Darzi's report open up a welcome opportunity for other clinicians - nurses and allied health professionals? Many hope so.

The challenge for nurses and allied health professionals is to understand the opportunity that is being offered to them. They need to step up to the mark with confidence and let their voices be heard. Nurses and allied health professionals are a large, important and influential part of the NHS. They have a vast amount of knowledge, skill and patient contact. Combined with the traditionally recognised skill and knowledge doctors have, this should provide a substantial and solid base for effective clinical leadership across the NHS. Nurses and allied health professionals may only just be finding their feet and voices in this area, but as their confidence grows and develops, so their step will become steadier and their voices clearer and more articulate.

The traditional view that "doctor knows best" can and should be challenged. The delivery of the next stage review should be about partnership, understanding and respect across all areas of the NHS.