Health reforms could spell the end of the NHS if nobody takes charge of running it, a leading businessman has warned.
In a report on the Government's NHS reforms for BBC1's Panorama programme, Sir Gerry Robinson said some local hospitals may have to close if the health service is to function effectively in the future and make the £20 billion savings needed.
The programme comes as the controversial Health and Social Care Bill returns to Parliament for further debate.
Former Granada chairman and chief executive Sir Gerry told the programme that reforms, including GP commissioning, should be made "extraordinarily carefully" and warned the NHS does not have the proper central management structure to take difficult decisions on hospital closures that are needed.
He said the Government's plans were fatally flawed unless they addressed the issue of who is running the NHS.
"I think the stakes here are huge, the very existence of the NHS could depend on getting this right," he said.
"Who's going to be managing that big picture? For me that's the question that remains, and unless somebody really does grab this thing at the centre and actually have the courage to make the decisions that are right but unpopular, I think it could be the end of the NHS."
But Health Secretary Andrew Lansley said the NHS would be safe under the reforms, telling Sir Gerry: "With a service the size and significance of the National Health Service, you've got to take people with you. You've got 50 million patients for whom it's always going to be an important thing.
"So they've got to know that when they hear noise about 'is the service going to be fragmented? Is it going to be safe in the future?'
"They need to know that it's going to be safe, and they need to know that the people who work in it are confident that it's going to enable them to deliver a better service in the future."