The public need to accept the closure of many hospital units and live healthier lives if they want the health service to survive, according to an NHS executive.
Hospitals will have to provide fewer services and beds if the NHS is to cope with growing demand caused by the ageing population, warns Mike Farrar, chief executive of the NHS Confederation, which represents hospitals.
Health professionals must do more to keep people out of hospital and treat them in or near their homes, while politicians should back the urgent and far-reaching changes needed to keep the NHS sustainable rather than joining protest marches, he added.
"Fundamental change" in the way the health service treats patients would produce better care, better value for money and better health outcomes. But this would mean "concentrating specialist expertise in fewer sites to enable patients to have access to the best round-the-clock intensive care, not shutting down services to cut costs", said Farrar.
Patients should demand the NHS provide more services that will see them cared for without having to go into hospital. Many of the older people who account for 70% of hospital bed days could be looked after elsewhere if more community-based services were available, he added.
In a message to MPs tempted to join local campaigns against the closure or merger of A&E, maternity and other services, Farrar said: "Politicians have a responsibility to inform their constituents about how changes to services can benefit them, not just lead marches to oppose them. Politicians can't vote to limit the resources of the health service with one hand and then resist change on the other when the service looks to make the most of the money it relies on from the taxpayer."
A recent poll of 99 MPs found widespread backing for more health services being delivered in the community, but considerable opposition to their local hospital losing key services as a result.
Farrar's uncompromising message prompted a debate about the service's future. Norman Lamb, the care services minister, backed the call for more preventive treatment and fewer hospital admissions. But doctors and other NHS staff were best placed to "look at how care and treatment can be improved and lead any reorganisation of services", he said.
But Dr Clare Gerada, chair of the Royal College of GPs, said Farrar had "let politicians off the hook" by stressing that NHS leaders and the public needed to support unpopular changes when that was ministers' responsibility.
MPs' backing for patients' right to choose which hospital to be treated in was unsustainable in an era of austerity "because choice introduces waste because to have choice you have to have excess capacity", said Gerada.
Politicians also needed to be honest about what the NHS could no longer afford, such as 24/7 care through walk-in centres, she added.
Dr Paul Flynn, chairman of the British Medical Association's hospital consultants committee, said the doctors' union "agrees that the NHS cannot stand still". But he warned against the service undertaking "constant overhaul" so soon after the reorganisation of the NHS in England imposed by the Health and Social Care Act 2012 and with £20bn of efficiency savings to be found by 2015.
He backed Farrar's call for patients to live more healthily to relieve the growing workload and to use medicines they have been prescribed, a move Farrar said would save £300m.