The wraps are finally coming off - region by region, details are emerging of what the review spearheaded by Lord Darzi will mean for patients and the balance of power in the NHS.

This week's publication of the first regional plans marks a renaissance for strategic health authorities. In recent months, as more and more acute trusts have reached the nirvana of foundation status and primary care trusts have pumped up their scrawny bodies on world class commissioning steroids, a long term role for SHAs beyond keeping an eye on PCTs has been increasingly difficult to discern.

But the strong regional emphasis of Lord Darzi's review as it reaches its climax has given new energy to the strategic part of being an SHA.

The relentless emphasis from the Department of Health on the local community as the starting point for health services is now giving way to discourses on local delivery of a regional vision.

The plan from NHS East of England exemplifies this shift, going into considerable detail about the services to be provided in each acute trust. No doubt there was intensive discussion with the PCTs, but they will still be charged with delivering the regional blueprint.

As each regional plan develops, with much more consultation to come, SHAs must resist the temptation to pick up where the Department of Health has been trying to leave off and emerge as the new centralisers. While there will be good clinical reasons why some decisions need to be taken across an entire region, this must not be allowed to subjugate the principle of "local where possible". SHAs should be judged on their success in giving PCTs the skills and space to determine their own way forward.

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