A long delay can create its own sense of drama - such is the case with the regulatory review which has been promised for the best part of a year and gone through various drafts (including a complete overhaul by McKinsey). In the event, the result published this week makes important changes but leaves some questions unanswered (Read news story here).

A long delay can create its own sense of drama - such is the case with the regulatory review which has been promised for the best part of a year and gone through various drafts (including a complete overhaul by McKinsey). In the event, the result published this week makes important changes but leaves some questions unanswered ( Read news story here).

Crucially, the 'super-regulator' formed by the Healthcare Commission and Commission for Social Care Inspection acquires the power to remove the licence of NHS organisations. An NHS landscape that has a greater variety of smaller providers and more entrepreneurial primary care needs a failure regime to match that of the independent sector.

That said, shutting down unregistered slimming clinics is not on a political par with taking apart a large-scale facility that will inevitably and immediately become beloved of the local community. Also, private hospitals need to apply for their licence - the review does not say whether all NHS organisations will automatically get their licence in the first instance.

The other clear direction of travel is the greater weight accorded to patient experience. It is no coincidence that the Department of Health plans to make patient 'reviews' key to GP practice ratings or that the prime minister's health adviser, Professor Paul Corrigan, has praised a website that collects patient judgments on local services (news, page 9).

What is less clear from the review is the relationship between the regulator and primary care trusts and the extent to which it and strategic health authorities share responsibility for commissioning quality. PCTs will need to know that the commission's criteria for judging problems dovetail with the SHA's judgement about how to solve them.

The Healthcare Commission will be more disappointed about the fact that although the review talks about strengthening the concordat between the regulators, it stops short of recommending a change in legislation that would make this compulsory. It looks difficult to strengthen it - something trusts would support - without a change to the law.