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The King's Fund said controversial sustainability and transformation plans (STPs), which aim to save cash but will lead to some cuts, offer the best hope of making progress in the NHS.

But Chris Ham, the think tank's chief executive, said the aim of cutting hospital beds, which many of the plans set out, is not realistic at a time when hospitals are already running at full capacity.

STPs have been created in 44 areas of England, setting out how the NHS will change services while also saving cash.

In several regions, the aim is to close or downgrade entire hospitals, while others suggest closing A&E departments or maternity, or merging some services.

All focus on a desire to stem the rise in hospital admissions by providing care closer to people's homes.

The new King's Fund report said there is currently an "uncertain" level of political backing for STPs, which were ordered to be drawn up by NHS England.

It argues politicians must face up to having difficult conversations with the public about which services should close.

Reconfiguring services "stands little chance of being implemented without support from the Government and a willingness to back NHS leaders where the case for change has been made", it adds, saying such support is "crucial".

Mr Ham warned a failure to support changes could lead to a continuation of unsafe services.

He said: "We think it is necessary to do because if you're not willing to do go through that process and support plans of this kind, essentially you are colluding as politicians in the continuation of unsafe services.

"Where there is a very clear evidence based case that local hospitals cannot continue providing safe high quality care because of a shortage of nursing staff, shortage of medical staff, and no doubt other factors too, then a reluctance to engage in albeit difficult conversations with the public, with local politicians about why the case for change is compelling and needs to be made, assuming it is, means that the public will continue to access services of a lower standard and a lower quality than they have every right to expect.

"So politicians need to step up to the plate and be brave.

"Not in all cases...because there have been examples of consultations in the past which haven't been well-founded.

"But where the evidence is clear, that's where Government and local politicians need to do their job."

Mr Ham said he did not agree however, with STP proposals to slash hospital beds.

The report said any plans to reduce hospital beds should be tested "if necessary to destruction".

Mr Ham said: "Cutting hospital beds when capacity is already being used at its limits, we don't think that's going to happen."

He said there was "no prospect realistically" of cutting beds when this winter had shown all the beds were needed.

"We do not think now is the time to start cutting back on acute hospital beds and capacity, anything like on the scale set out in some of the plans."

He said axing hundreds of beds was "simply not credible given the state of our acute hospitals this winter, which is likely to be similar next winter".

Last November, the King's Fund said STPs had been kept secret from the public and barely involved frontline staff.

NHS England ordered local health leaders not to reveal the plans to the public or the media until they were finalised and approved by their own officials first.

It even told local managers to refuse applications from the media or the public wanting to see the proposals under the Freedom of Information Act.

Asked if NHS England had contacted the King's Fund after that report was published, Mr Ham said: "We talked to NHS England we talked to NHS Improvement about our report.

"They thought we were quite critical of the process but we stood behind the line we took because we reached the decision to highlight the weaknesses in the process based on the many interviews we'd undertaken."

He said that as an independent organisation, the King's Fund would be "falling down on the job" if it was to give in to any pressure.

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