Twenty hospitals across the country must be taken over, merged or closed if the NHS is to improve patent care and keep within its budget, the head of a leading health think tank warned yesterday.
Professor Chris Ham, chief executive of the respected King's Fund, called for politicians to be "distanced" from having to make the decisions on which hospitals should shut – hinting that they were too likely to give way to local pressures.
He is the second senior health figure to call for a wholesale rethink of hospital provision in England.
Last week Peter Carter, head the Royal College of Nursing, said England had far too many acute hospitals in urban areas which was a drain on the system and should be replaced with care in smaller, community-based units.
More than two thirds of the £100 billion NHS budget is spent on long-term conditions that are increasingly being treated out of hospitals, which remain the most expensive part of the health service.
Writing in The Observer, Professor Ham suggested up to 20 hospitals needed wholesale reform.
"Several hospitals have large deficits and it is clear that existing services cannot be sustained either clinically or financially," he said.
"Financial pressures are increasing by the day and will adversely affect quality unless ministers recognise the urgent need to change the way services are provided.
"Up to 20 hospitals, around 10 per cent of the total in England, may not be financially sustainable and will have to be merged or taken over. Many others face financial or clinical challenges that require changes to the services they provide.
"Governments have ducked these issues for too long, while MPs have ignored clinical and financial evidence and backed campaigns to keep local hospitals and specialist units open."
The professor said decision-making power should be handed over from the Health Secretary to the Independent Reconfiguration Panel, who currently pass on their recommendations to ministers.
This would make sure vital conclusions are reached without political pressures, based solely on clinical and financial issues.
"Unfortunately, the process for 'reconfiguring' services is not fit for purpose," said Professor Ham.
"Under the current system, the secretary of state is the final arbiter, with contentious decisions referred to him by the Independent Reconfiguration Panel (IRP) – a body of experts charged with reviewing decisions that cannot be resolved locally."
He added: "Giving the IRP responsibility would avoid delays under the current process and ensure they are taken on clinical and financial grounds rather than for political reasons."
Senior figures in the Department of Health are aware of the need to reconfigure hospital services, but fear closures could be portrayed as examples of cost cutting to save money rather than being beneficial in their own right.
Such a portrayal would be politically toxic for David Cameron who delayed and amended the health reform bill in part to prove that the Coalition could be trusted on the NHS.
Trusts in danger
* Barking, Havering & Redbridge Hospitals
Received £140m in bailouts in the past five years. Measures to cut spending including ward closures have led to increasing waiting times.
* West Middlesex University Hospital
With £21m of debts, managers have indicated that an A&E unit may shut.
* Epsom & St Helier University Hospitals
The trust plans to cut 12.7 per cent from its £313m turnover in 2011-12.
* South London Healthcare Trust
Received nearly £100m in bailouts over the last two years. It closed the A&E and maternity unit at one of its sites in December, but is likely to need further action to balance the books .
* Barnet & Chase Farm Hospitals
Campaigners have fought for years to keep the A&E and maternity services open, despite doctors and managers saying that they were not financially or clinically sustainable.