The NHS needs a new “vision” if it is to improve and should cut the number of hospitals and consultants to do so, one of its former chief executives has said.

Lord Crisp, who led the service under Tony Blair from 2000 to 2006, told the Daily Telegraph: “This is about releasing money from the old infrastructure to put into the new, and it’s about moving from the 20th century model of healthcare to the 21st.

“They’re putting GPs in the driving seat, which may or may not be a good thing, but they’re not concentrating on what really needs to be done, which is building a different sort of NHS.

“I think they need to set out a vision for the NHS and I just don’t think they’ve done it.”

The former chief told the newspaper the current infrastructure was “inefficient” and it “isn’t being used to its full capacity”.

He said: “You’ve got beds closed and people not working to their full capacity because there are too many sites.

“In some ways we provide too many very highly-trained people who then have to work below their capacity.

“If you’re going to effect the cost base of the NHS you’re going to have to effect the staff costs, and some of that will be about changing the staff mix rather than just changing numbers - changing the staffing pyramid so there are more people at the base and not so many at the top.”

David Stout, the deputy chief executive of the NHS Confederation, said if the organisation was to improve, it was “likely” some hospitals would be shut down and care would be provided differently in the community.

He 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.”