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£20Billion will only be sustainable if it comes from evidence-based, consensual, intelligent, patient-focused Design. This requires greater Investment in strong Leaders & competent Managers, & better Tools to support decision-making particularly as the £20Bn is not about simple Cuts but must include optimal Resource re-Allocation Decisions & better Investment Choices. More than anything, you have to Invest the time & energy & get the data if you want to deliver sustainable QIPP & to do this there must be a level of "productive administration" because even the people in the 'back office' can & must make a big, positive impact on Delivering Optimal Care, by Design.