Progress in the NHS has been hampered by two major reorganisations since reforms were introduced in 2000, a report concludes today.
The study from the Audit Commission and Healthcare Commission advises that nationally-imposed changes to the structure of the NHS should be avoided to allow progress to take place.
It also says that progress could have been greater had the capacity to commission patient services been greater and if there were fewer weaknesses in the systems to support and monitor improvements.
The study reveals that there has been limited progress moving care out of hospitals and closer to home.
Evidence was found that patient choice can work but, to drive improvement, the choices offered to patients for treatment need to be realistic and supported by more timely and accurate information than is currently provided.
Reforms that are beginning to work include better financial management of the NHS and the commissions say competition, or the possibility of it, has led to improved services in some areas.
"It's clear that the reforms have not yet achieved what was promised and that progress is behind what some might have hoped for at this point," said Healthcare Commission chairman Sir Ian Kennedy.
"These policies are only a means to an end. They have got to make the care of patients better. Yes, they have triggered improvements for patients, but there's still some way to go."
Audit Commission chairman Michael O'Higgins added: "We don't under-estimate the scale of the challenge of reforming the NHS.
"But given the massive investment in the NHS in recent years, taxpayers and patients rightly expect that their money is spent as efficiently as possible and that services are improving. The NHS must keep the pressure on to make these reforms work for patients."