One in four NHS hospital patients would be better off treated at home, the head of the NHS trusts organisation has said.
Mike Farrar, chief executive of the NHS Confederation, called for more services to be provided by GPs and local clinics and for less reliance on hospitals, to raise standards, cut waste and boost confidence in the NHS.
And in a sideswipe at ministers he said there has been a lot of talk about changing services but little action. "It often feels like the focus is on everything but the thing that would make most difference."
The current way of delivering care mainly in hospitals is outdated, he said.
"Hospitals play a vital role but we do rely on them for some services which could be provided elsewhere. We should be concentrating on reducing hospital stays where this is right for patients, shifting resources into community services, raising standards of general practice, and promoting early intervention and self-care.
"[This] is not just about money – it's about building an NHS for the future."
Despite being protected from cuts, the NHS budget is under pressure from rising demand and the requirement to make £20bn of efficiency savings by 2015, to fund future rises in demand.
Evidence shows that early intervention can reduce hospital admissions and concentrating specialist services in fewer hospitals increases standards. But history shows that hospitals jealously guard their resources. There are no votes in closing hospitals and politicians have opposed reforms even where the case for change is clear.
Mr Farrar criticised the lack of political and clinical leadership needed to bring about change and warned that perverse financial incentives could delay progress.
"There is a real danger of distraction. We must not allow that to happen if we want 2012 to be a success."
The Health minister Simon Burns, said: "The challenges of rising demand, an ageing population and increasing costs of treatment won't be met by the NHS doing more of the same.
"Our plans give doctors, nurses and frontline professionals the freedom to make the best decisions for patients."