Key hospital departments across England could be closed in the run-up to the next general election, according to the new chief executive of the NHS.
In an interview with the Guardian chief executive David Nicholson said there would be up to 60 "reconfigurations" of NHS services affecting every region in England.
The changes are expected to affect accident and emergency and maternity departments, especially in smaller district hospitals.
Mr Nicholson said some changes will be aimed at reducing the NHS's deficit, which was £512 million last year.
But he stated most would be aimed at improving the NHS by providing concentrated key services in fewer hospitals.
And he warned the NHS was unlikely to achieve Tony Blair's pledge that all acute hospital trusts should be ready to apply for foundation status by 2008.
Accident and emergency departments, paediatrics and maternity services have been identified by the newly appointed boss as areas due to be overhauled.
He said: "Undoubtedly there will be tough decisions to make over the next 12 months to reflect changing services.
"Some will come sooner (than the general election). We are going to have to tackle the big patient issues. I understand the politics of it, but this is about the way we deliver care which is predominantly closer to home."
The implications of the changes are understood to mean patients may get a better service, but they will have to travel further to access it.
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