Lord Darzi’s report ‘High Quality Care for All’ (Department of Health, 2008) appears at least on the surface to continue or replicate previous rhetoric by promoting quality care and mechanisms for testing initiatives to prove that quality of care is given. The quality word has been overplayed in many White Papers, and no one would argue that we need to strive for higher standards. Yet with the service already stretched to its limits, how can all this be achieved? Over the years there have been a number of government reports which all seem to demand higher quality. However, most healthcare professionals would agree that without proper resources, these demands for high quality will be difficult to achieve. So, what is it that makes the Darzi report different?