Radical change is needed to ensure people get better healthcare and value for money, the NHS Confederation has said.
According to the confederation's deputy chief executive David Stout, in response to Monitor's annual review of foundation trusts, the real challenge will be managing increasing costs for the growing rates of lifestyle diseases such as obesity.
He said: "NHS leaders know the real challenge is to tackle a flat budget while managing increasing costs. For example, treating an ageing population and advanced technology.
"And they know that doing this will require more radical action. It will require further integration of services and expanding community-based care. This is necessary to avoid the financial pressures harming patient care."
The Monitor review, published today, showed the sector continues to face challenges in meeting greater demand and more stretching healthcare targets.