Slashing NHS bureaucracy is key to improving frontline health services, according to Conservative Shadow Health Secretary Andrew Lansley.
He cites the £1.94bn a year spent on quangos, the rising budgets of PCTs and the cost of the Strategic Health Authority.
Mr Lansley claims that slashing NHS red tape could save £4bn over four years, including an £850m dividend if trust and quango budgets were cut back to 2003 levels.
Backing estimates by NHS chief executive David Nicholson that £15-20bn of savings must be found between 2011-14, he said the Tories would "go much further in slashing wasteful bureaucracy in the NHS hierarchy".
He said: "To make the NHS successful we must devolve decision-making closer to patients. In doing so we'll save substantial sums of money."
The Tories have pledged that if they win power, frontline service budgets would be spared the axe.
The party's annual conference in Manchester heard that because budgets come under the direct control of ministers, the latter could give a "concrete commitment to cut them by a third".
Mr Lansley said that scrapping some Whitehall-imposed targets and giving GPs power over budgets and out-of-hours care would also help.