The NHS faces further radical change, including the closure of hospitals and services, if it is to continue offering high-quality care, its outgoing chief executive has said.
Sir David Nicholson said that with limited growth in prospect for the future, the only alternative to change was "managed decline". Addressing a conference of NHS managers in Liverpool, Sir David said the NHS had to escape the "tyranny of the electoral cycle".
He added: "Politicians will never run round saying 'close hospitals' – it is our job to make the arguments with patients." NHS England will produce a strategy of what the NHS "could look like", he said.
Jeremy Hunt, the Health Secretary, told the conference that NHS bosses had been given a year to develop a "vulnerable older people's plan" to help the heaviest users of NHS services and A&E departments. Mr Hunt also said that GPs needed to take more responsibility for out-of-hours care.