The NHS constitution should include a financial charter setting out how commissioners must achieve value for money, rather than just a set of anodyne values, a think tank has claimed.

Reform's report, Demand for a New Era, says the NHS will be unable to respond to rising costs because the Darzi review has ruled out reforming the way the NHS is funded or structured.

The constitution will set out NHS values, such as taxpayer financing, and entitlements and responsibilities for patients. But Reform says an economic element is needed to make it possible to achieve these values and bring about structural change.

It recommends commissioners are duty bound to secure best value for service users and provide information on quality, costs and budgetary programmes to make it possible.

Report author Nick Bosanquet said profit and loss accounts are not available to teams to allow commissioners to use funds more effectively. As a result the health service was wasting an awful lot of money on "completely obsolete activities".