A former head of the NHS has called for more hospitals to be closed to enable the health system to succeed in the future.
Lord Crisp, who was the NHS chief executive and permanent secretary of the Department of Health between 2000 and 2006, said building programmes had gone too far, leading to overcapacity.
He has called for an overhaul of hospitals to free up funds for community services to deal with the ageing population.
In an interview with the BBC News website, Lord Crisp said: "In the late 1990s, waiting lists, A&E and standards in cardiac care were the big issues and we dealt with them.
"But the challenge now is dealing with the numbers of older people and those with long-term conditions. They need supporting in the community.
"That means a shift away from hospitals. There will be less need for large hospital outpatient departments and some services and whole hospitals will need to close or be merged with others."
He added that the scale of hospital building had been excessive, with more than 100 new hospitals or rebuilds taking place.
He said that smaller facilities would have enabled services to be provided more efficiently to patients.
Katherine Murphy, of the Patients Association, agreed the government should not be afraid of making difficult decisions.
She said: "What is the point of having brand new hospital buildings if there are not enough funds to treat people in them?
"We must never forget that by merging services, there will be patients who may struggle to get to them because they are too far away."
Dr Ros Altmann, director-general of over-50s organisation Saga, said that community care should be improved before hospitals were cut.
He said: "This is the right idea, but gets things in the wrong order.
"In reality, the faster and more comprehensively domiciliary care is developed - backed by a robust and realistic care funding process - the sooner hospital costs and demand for beds will fall.
"If hospitals are closed or departments contracted before the social care system - particularly domiciliary care - is developed, then matters will get worse rather than better."
A Department of Health spokeswoman said: "In a modern NHS, not all patients need to go to hospital to get treatment.
"More and more services are provided in the community or even at home, which is what many people want.
"Hospitals will still have an important role in treating patients, but the important thing is that the right NHS services are available in the right place and that the NHS is able to fit around its patients - not expect patients to fit around the NHS.
"Any service reconfigurations will be subject to four tests. They must be supported by GP commissioners; strengthen public and patient engagement; there must be clear clinical evidence supporting the reconfiguration; and the change must not limit current and prospective patient choice."
NHS Confederation deputy chief executive David Stout said: "NHS leaders will have to make some tough decisions if the health service is to live within its means.
"This is a pressing issue and one that we must tackle now so that patients can continue to have access to the high quality care they expect.
"NHS organisations must find new ways of delivering services if they are to respond to growing demands on healthcare and increasing financial constraints.
"In reality, this is likely to mean closing some hospital services, having fewer hospital beds and providing care in different ways, particularly in the community.
"This is not a counsel of despair. If we get it right, this can be about protecting and improving the quality of care patients have access to. But there is no question about it - we are going to have to do more for less.
"Now is not the time for inertia. But it is essential any decisions on changes to local services are based on evidence and have the support of clinical staff and local politicians."
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