Jeremy Laurance: New answers, but there's still the £20bn question

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The sound of screeching brakes could be heard in University College Hospital as David Cameron engaged reverse gear on NHS reforms.

The Prime Minister rowed back from one key element of the Bill after another. Everything would change, he tried to suggest, yet everything would stay the same. The re-framing of the role of Monitor, the economic regulator, to focus on integration rather than competition will worry reformers. Without competition, how will the NHS be induced to modernise?

GPs will not be granted sole control of £60 billion of NHS funds but must share it with hospital colleagues. How will this improve on primary care trusts? Perhaps his most foolhardy pledge was to protect NHS funding – in the face of an estimated £1 billion shortfall.

The toughest call however may be maintaining maximum waiting times at 18 weeks. That highlights the biggest omission from the speech – any mention of the eye-wateringly large £20bn the NHS must save over the next four years. It was hard to see how this would be achieved with the full-blooded reforms set out by Andrew Lansley in December. It is even harder now.

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