There is no doubt Lord Darzi is a distinguished surgeon, respected and trusted by professional colleagues. And this is at once the strength and weakness of his final report.

It enabled him to secure the support and participation of a wide range of professionals in conducting his review. It lends serious credibility in many quarters, even if consultation with patients and the public was thin on the ground.

There are many recommendations that put clinicians and medics firmly back into key positions in decision making processes locally, regionally and nationally.

However, it is on the accountability front that the Darzi vision crumbles for me. I'm not sure I saw the word "democracy" once in the report. After decades of struggles to get a foot in the decision making door for patients and the public, are we now handing power right back to clinicians and staff?

The only accountability mentioned in detail in the review is that to be afforded to individual patients, who quite rightly ought to be fully involved in their treatment, which should be the best it can be. But accountability in the NHS was never just about that - it has a public and community dimension too. And it is as citizens, as well as individual patients, that we pay for it and want to have a say in how it is shaped.

Sharon Grant, chair, Commission for Patient and Public Involvement in Health