Every strategic health authority region will be told to re-examine its Darzi strategy to take account of the toughening financial regime.

NHS chief executive David Nicholson told HSJ he will ask regions to assess how their visions for acting on Lord Darzi’s next stage review, published a year ago, will be achieved despite looming budget cuts after 2011.

He said next year’s operating framework will call for a “properly resourced” implementation plan for each regional strategy. Many contained few costed proposals when published last June.

He said: “There’s a need for each of the regions to think about how that regional strategy can be delivered in the period we’ve got coming up. I’ll be asking each of the regions to do that over the next nine months… in light of the recession. There are visions which are great but now we need to start thinking about what underpins them.”

NHS South West has set itself a referral to treatment target of eight weeks for 90 per cent of admitted patients and 95 per cent of non-admitted patients by 2011 - much tougher than the NHS-wide 18-week target.

Mr Nicholson highlighted this as one goal to be looked at: “[The target] will have been decided on the basis of where they thought they would be.

“They need to think whether, given the resource arrangements, we can sustain that.”

Asked whether regional and national plans created during a boom period would be deliverable in a recession, he said: “We were always pretty clear that the days of plenty were coming to an end. We didn’t know of the scale of the productivity challenge over the next five years but now it’s pretty clear.

“But we think the overall strategy is the right one [to focus on]. Improving quality is the best place to start.”

NHS Confederation policy director Nigel Edwards said managers were “optimistic” about their regional visions: “When we add up the various good ideas that underpin the strategies, they may cost money but improve efficiency.”

But he said any revisions would have to be big enough to release cash savings, which may involve reconfiguring services sooner than planned.

South Central is expected to be the first region to bear the brunt of reduced public spending as it receives the lowest funding levels per head and has the smallest surplus.

NHS South Central chief executive Jim Easton said impending spending cuts had brought the need to configure services in the most sustainable way “into sharper focus”.

He said: “It would be a derogation of our duty to back off the commitment to improve quality.”

NHS North West chief executive Mike Farrar said his region planned a “summit” next month: “There might be programmes that we will now consider that we might otherwise not have, for example pushing harder at the health and local government boundary.”

An NHS South West spokeswoman said the SHA’s plan would save costs by delivering services more efficiently.