Next year could be the "toughest" the NHS has faced in its 62-year history, hospital managers have warned the Government.
Patient care could suffer and hospitals close unless ministers can successfully manage their ambitious £15-20bn efficiency drive alongside the wholesale re-organisation of NHS structures.
The warning came from Nigel Edwards, acting chief executive of the NHS Confederation, which represents hospitals and trusts.
"There is no escaping the conclusion that 2011 will be really tough for the NHS, possibly the toughest year it has faced," he said. "If the issues are not fully recognised, they will be dealt with poorly and patients will be the losers.
"We need policy makers to fully understand the pressures, to act to mitigate the risks and to persuade those involved that we are on the right course. The Government... must tell a compelling story about why the reforms will deliver a significant improvement for patients and how [they] will actually work."