The NHS needs to cut the number of hospitals and consultants, one of its former chief executives has said. Lord Crisp, who led the service under Tony Blair from 2000 to 2006, said a new "vision" is needed for it to improve. "They need to set out a vision for the NHS and I just don't think they've done it," he said.

The former chief was reported as saying infrastructure was "inefficient" and "isn't being used to its full capacity". He said: "You've got beds closed and people not working to their full capacity because there are too many sites.

"If you're going to affect the cost base of the NHS you're going to have to affect the staff costs, and some of that will be about changing the staff mix rather than just changing numbers – changing the staffing pyramid so there are more people at the base and not so many at the top."

David Stout, the deputy chief executive of the NHS Confederation, said if the organisation was to improve, it was "likely" some hospitals would be shut down and care would be provided differently in the community. "NHS leaders will have to make some tough decisions if the health service is to live within its means," he said.

"NHS organisations must find new ways of delivering services if they are to respond to growing demands on healthcare and increasing financial constraints. This is likely to mean closing some hospital services, having fewer hospital beds and providing care in different ways, particularly in the community."