The NHS will not survive unless there are radical changes in the delivery of healthcare such as hospital closures and centralisation of services, experts said.
If there is not "fundamental change" to the health service, there could be more and more instances of the appalling care suffered by patients at Stafford Hospital, health officials warned.
An ageing population, more and more people suffering from long-term conditions and a stagnant budget are compounding factors putting pressure on the system, NHS England said.
And if health services in England were to continue delivering care the way it is currently delivered, there will be a funding gap of £30 billion between 2013 and 2021, even if the health budget is protected, officials said.
So to maintain a health service that is "free at the point of use" a new approach to the delivery of services is "urgently needed", they said.
A new NHS England document says that improving the current system "will not be enough", adding: "Without bold and transformative change to how services are delivered, a high quality yet free at the point of use health service will not be available to future generations."
Officials have not yet decided how the health service must change and have decided to open up national debate to "flesh out the no-go areas".
But plans to make changes to health services have been ferociously opposed in the past.
For instance, the streamlining of children's heart surgery services ended up in a bitter legal dispute. And campaign groups in Stafford are battling to maintain services at Mid Staffordshire NHS Foundation Trust - even though Stafford Hospital was at the centre of a care scandal that rocked the system to its core.
NHS England said that moves such as the centralisation of services - where care is concentrated in a few specialist centres to ensure quality of care - would form part of the transformation.