Health secretary Alan Johnson told last week's NHS Confederation conference that the report's contents would be 'determined by the local visions published by each SHA'.

Clinicians, patients and managers are best placed to improve patient care, he added.

Mr Johnson repeated his pledge that the report will not include 'top-down reorganisations' of the NHS.

And, while existing targets on infection control and waiting times will remain in place, 'there will be no new national targets'.

His comments were backed by NHS chief executive David Nicholson, who hinted that the system had become too reliant on central direction.

'In some places people now say, "We've got to reduce waiting times because the government tells us we have to". What a terrible place to be.'

He said the review would create a framework in which clinicians, not SHAs, could set priorities. 'When we talk about localism, we don't mean replacing being told what to do by government with being told by a smaller number of people,' he said.

But a leading health policy expert questioned whether reform was possible without central direction. 'I suspect targets will have a part to play in implementation,' former DoH advisor Professor Chris Ham said in last week's BMJ summer lecture. 'But that approach won't be the only way forward.'

Mr Johnson said that the review would be published alongside a Primary Care Strategy, which 'will put primary care centre stage' in tackling public health issues.

jonn.elledge@haymarket.com

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