The NHS must change if it is to survive and remain sustainable.

That was the blunt message from NHS England’s chief executive Sir David Nicholson to the Health and Care Innovation Expo today.

“We need to put systems in place that make change happen,” he told a packed audience. “This is a matter of survival for the NHS.

“We are at a fork in the road. Those who say we can muddle through for two or three more years as we are and sustain the NHS are wrong. The old ways will not sustain it and we will only see a managed decline.”

Sir David was joined on the Community Stage at Manchester Central by MP Stephen Dorrell, the chairman of the Health Select Committee, and Dame Ruth Carnall, the former chief executive of NHS London and healthcare consultant,  to debate ‘Is reconfiguration a luxury or a necessity?’

Sir David said several major changes had to be put in place including empowering people to take charge and make decisions about their own health and care.

“Changes are about organising services around individuals and we need to make sure we have primary care services that can support 7-day working. We need to integrate services, we need to be efficient in elective services and urgent and emergency care services need to be fixed.

“All this is a significant challenge and involves a change in the way we deliver services. It is difficult and it is tough.

“We need to nationally make the case for the change. We need to be shoulder to shoulder in these changes and tackle the politics.”

Stephen Dorrell said he regarded the subject of the debate as “a rhetorical question”, adding: “Reconfiguration is NHS jargon for ‘change’, and we should embrace change.

“The NHS needs to change because the demands we are being asked to meet are changing. The needs of the citizens we now provide services for are different from the needs of the citizens that the system grew up with.

“Reconfiguration must be at the core of the management’s objectives as it moves forward.”

Dame Ruth added: “How did we come up with a word like ‘reconfiguration’? I suspect to most of the public it means cuts and closures.

“We have unacceptable variations in the standards of care. And the financial gap is getting wider. Put those two things together and it tells me the NHS is unsustainable in its current format.”