Meeting the financial challenge of the next three to four years is the subtext to the current NHS reforms in England. Although there is dispute about whether changes proposed in the Health and Social Care Bill1 are evolution or revolution,2 any changes must produce better results for patients in a climate of financial challenge.3 Amid the current debate, which often blends ideology with fact, opportunities may be created that could safeguard the NHS for the future and enable it to deliver more for those it serves within available resources.

One widely acknowledged positive change is the emphasis on delivering better outcomes.4 Evidence is mounting that specific elements are important to ensure this: transparent data linked to information systems; greater patient involvement; clinical leadership; more service integration; and, in certain circumstances, elements of competition—on quality, not on price.5

We think that an additional opportunity is created by the funding squeeze itself: a …