Hospitals may need to turn to private sector takeovers, mergers and more community-based care to ensure they survive the NHS reforms, the head of the health service has claimed.

Sir David Nicholson said the scale of changes and severity of spending cuts meant some hospitals would find the future “difficult” and have to adapt to remain competitive.

However, he said the “expectation” was that no hospitals in England would completely close.

Speaking to the BBC he said: “Most hospitals will be able to survive and thrive in the new world. But undoubtedly there will be those that will find it difficult.

“The thing about the hospital service is that it has grown enormously over the last 10 years in particular and we are going into a period where growth in the NHS is what they describe as ‘flat real’.

“Those hospitals whose business model is based on increasing capacity have got to seriously look at the way they operate.

“That is why some hospitals are looking towards taking over community services.”

Sir David, who will become the chief executive of the NHS Commissioning Board when GP consortia are introduced, said some hospital trusts may have to merge with their neighbours, which could lead to the reduction of some services. He also added that some may be taken over by private companies to ensure their survival.

The health chief described the NHS’s financial situation, which will see an annual budget rise of 0.1 per cent above inflation for the next four years, as “difficult”.