Unleashing the most effective drivers to transform the NHS could end the unsustainable rise in health spending and stabilise it as a share of GDP. After analysing the effectiveness of six common 'reform levers' across health systems of comparable countries around the world, this report concludes that the UK government should rely less on the familiar use of targets, competition and choice, and regulation, although all still have a role to 'shore up performance'. Instead, it urges the government to use various levers of reform including: empowering frontline staff and patients to drive improvement, and deepening the NHS’s approach to devolution.