The NHS cannot survive in its current form and problems could escalate to the point where anyone who can afford it will choose to go private, the chief executive of NHS England has warned.
Sir David Nicholson said the health service needed to undergo a major programme of centralisation of services, including having no more than 70 major accident-and-emergency departments and reducing the number of cardiac care and transplant organisations from 300 to between 15 and 30.
This transformation would require a major investment of cash by the next Government, but if it did not take place Sir David warned the NHS would face a “managed decline” with rationing of treatment, longer waiting times, fewer nurses and poorer care.
He predicted the “huge” and “unprecedented” changes would be “painful for staff” and difficult for the public to accept, but were necessary to ensure the survival of the system.
“The NHS in its current form is unsustainable,” Sir David said in an interview with The Guardian.
“I don't think the wheels are going to fall off tomorrow. But we'll see a position where people have to reduce the number of nurses on the wards and have to reduce the drugs that we give to people.
“I can see all of those things happening unless we embrace this change.”
Public support was “so important for a taxpayer-funded system” and the NHS enjoyed greater backing than almost any other system in Europe, he said.
But he added: “My worry is that if it gets worse, before you know it you get to a place where a minority of the people support it and then people who can afford to will go elsewhere for their healthcare.
“In those circumstances the question of how sustainable the NHS is becomes a much more difficult one to deal with. That's my worry.”
Sir David said concentrating specialist services “leads to better outcomes for patients”. There would also need to be “more preventative work” in the community to reduce the pressure on hospitals.
Paul Burstow, a Liberal Democrat who was a health minister until 2012, said Sir David’s message was “a realistic assessment of what's needed to make change happen”.
But he added that it would be “unwelcomed by people in all the parties responsible for Treasury policies”.
Professor Chris Ham, chief executive of the King's Fund health think tank and a former adviser on NHS issue to David Cameron, said their research had confirmed that it was “inevitable that the next government will need to find additional funding for health and social care”.
“The alternative is to accept significant cuts to services that will harm care,” he added.