The language used by the chair of the Care Quality Commission in her interview with HSJ was typically clear, robust and ambitious.

The relationship between a regulator and its sponsoring department is always liable to be difficult; several chairs have been pushed out over the years. Baroness Young is renowned for being fiercely independent in her thinking, so her appointment was a promising sign that Department of Health ministers were happy to have a regulator who was not afraid of political rough and tumble.

And it gets better. Baroness Young revealed that in all her public sector postings she had never been encouraged by so many ministers to be independent. With her at the Care Quality Commission and Bill Moyes at Monitor, no-one can complain that the healthcare regulators are not supporting trusts in creating more distance from Whitehall control.

She has buried the notion that trusts at the bottom of the performance pile will not be able to register to provide services. Instead of using the registration process as a threat, it will be a tool to agree an improvement plan with the stragglers.

Speeding ticket

Under the leadership of Baroness Young and chief executive Cynthia Bower, the Care Quality Commission can be expected to move fast. The chair is clearly anxious to swing the regulatory tanker round towards outcomes and quality as quickly as possible.

Speed is welcome in principle, but must be balanced with the requirement to involve trusts in determining how regulation will be structured and how inspection will be proportionate to risk.

The tough part for the commission's leadership will be running an organisation composed of at least three cultures from its predecessor bodies and regulating a health service with many more besides - acute and mental health, hospitals and local government to name just a handful.

The signals about Baroness Young's desire to pull the whole of primary care under the commission's remit are good news. It would be an act of cowardice if ministers announced in the autumn they had decided to backtrack.