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The English healthcare sector underwent extensive system reform over the period from 2010 to 2015, aimed principally at improving technical efficiency. This paper examines the effect of the reforms on foundation trusts in England with particular emphasis on technical efficiency. By employing data envelopment analysis (DEA) and a second-stage regression, we found evidence of an overall improvement in efficiency, notwithstanding some fluctuations. Specifically, we found that bed utilization had positive and statistically significant association with the efficiency of acute foundation trusts; suggesting that better management of patient flows and bed utilization might be expected to improve hospital efficiency. We also found evidence to suggest that efficiency might also be improved through better management of staff numbers, optimizing liquidity, and better utilization of assets such as buildings and information technology. [ABSTRACT FROM AUTHOR]