Health secretary Andrew Lansley has warned the NHS it cannot expect the funding increases it has enjoyed in the recent past and it will not be protected from change.

Speaking at the NHS Confederation conference, Lansley said that while “funding for the NHS will continue to rise in real terms” the real terms increase “will not be of the order of recent years.”

Indeed, he said it would provide only a “measure of protection” and it would be essential to use the money that was available effectively. “Protection for the NHS is not protection from the need for efficiency,” he warned, “it is protection for patients.”

He told managers assembled at the conference in Liverpool’s docklands that this lay behind the demand for massive management cost savings laid out in the revised Operating Framework issued by the Department of Health this week, and the curb on capital spending laid out by the Treasury.

He also confirmed that the NHS will be expected to making efficiency savings of at least £20 billion over the next four years, but argued these should not be seen as cuts. “It is not about doing less or worse. It is a £20 billion efficiency saving; it is doing more for less,” he declared.

Lansley said he wanted “far reaching” change in the NHS to give more power to GP commissioners and patients, to focus on outcomes rather than targets, and to “empower” clinicians to deliver the Quality, Innovation, Productivity and Prevention agenda.

A theme of the conference is uncertainty about what this change may look like, whether the new government has a plan to get from the NHS’ current management structures to the GP commissioning consortia that will be expected to take on much of their work in the future.

There is also concern about the timescale for the changes that must be made, given that the NHS’ current settlement with the Treasury runs out in March. Many managers at the conference were hoping that Lansley might indicate when the new Health Bill will be published and when the government will pass the legislation needed to implement much of its agenda.

However, Lansley stuck to broad principles in his speech, saying only that more practical details would be provided by NHS chief executive Sir David Nicholson tomorrow, and that he would take steps in the future to “create a bridge between the past and the future and to help map the journey we need to take.”

The NHS Confederation published a report today showing that many previous reform attempts have failed, not least because ideas pursued by one government or minister are frequently reversed by another.

Speaking yesterday, NHS Confederation acting chief executive Nigel Edwards said the Health Bill would result in a “fundamental shift in how power and accountability works in the NHS” but there were going to be some “very difficult times ahead” and “transition to the new system looks tough.”