Plans are being drawn adult that could see cuts to NHS services opposite England.
The BBC has seen breeze sustainability and mutation skeleton (STPs), that introduce changes to sanatorium and GP services.
NHS England says reorganising internal services is essential to urge studious care.
But a consider tank warned that while STPs could lead to “fundamental changes”, they had not been “visible” enough.
In all, 44 STPs are being drawn adult by internal health and amicable caring leaders.
They were asked to find intensity assets and efficiencies during a finish of final year.
Despite being due for pointer off in October, many STPs are still unpublished.
They are expected to be implemented in a new year.
The NHS needs to find £22bn in potency assets by 2020-21 to accommodate a financial targets set out by a former Chancellor George Osborne and NHS England conduct Simon Stevens.
The discuss organisation 38 Degrees unclosed many unreported breeze STPs, including skeleton for a closure of Midland Metropolitan Hospital’s collision and puncture department, a merging of dual of a area’s 3 district ubiquitous hospitals and a closure of one site.
In Leicester, Leicestershire and Rutland, there are skeleton to revoke a series of hospitals in a area from 3 to two.
There are also skeleton to put GP surgeries underneath “review” since of a necessity of funding.
There have been no consultations on a skeleton so far.
A breeze devise present among NHS managers in West Yorkshire reveals proposals to tighten a homogeneous of 5 wards in a Leeds Teaching Hospitals Trust.
A mouthpiece for a area said: “We will be enchanting and consulting as and when appropriate.”
In a blog published on a Nuffield Trust website, a head, Nigel Edwards, pronounced STPs had “the intensity to make elemental changes in a figure and inlet of health and caring services”.
But he added: “The routine to figure these skeleton has meant that they have so distant not been really visible.”
Sally Gainsbury, comparison process researcher with a trust, said: “It looks like utterly a lot of these skeleton during a impulse are proposing big, large-scale reconfigurations – that’s changeable services or shutting services down.
“Our investigate finds that, in a lot of these kinds of reconfigurations, we don’t save really most income – all that happens is a studious has to go to a subsequent sanatorium down a road.
“They’re some-more inconvenienced, they have to transport further, though it frequency saves a income that’s needed.”
A NHS England orator said: “This is a singular use in collaboration. It is frequency a tip that a NHS is looking to make critical efficiencies and a best approach of doing so is for internal doctors, hospitals and councils to work together to confirm a approach brazen in conference with internal communities.
“Proposals are during a breeze theatre though we design all internal leaders to be articulate to a open and stakeholders frequently – it is critical that people are means to figure a destiny of their internal services.
“No changes to a services people now accept will be done but internal rendezvous and, where required, consultation. There are longstanding declaration processes in place to make certain this happens.”
38 Degrees executive Laura Townshend said: “This is new justification that skeleton are being done to tighten internal NHS services.
“We all rest on these services, nonetheless we are being kept in a dark.
“These due cuts aren’t a error of internal NHS leaders.
“The health use is struggling to cope with flourishing black holes in NHS funding.
“The NHS belongs to all of us – so internal people should get a contend in any changes to their internal services.”
David Pearson, STP personality for Nottinghamshire, told BBC Radio 4’s You and Yours programme: “Sometimes, we have sold conditions or sold treatments that are best in a centre of excellence.
“So, that’s partial of a discuss we will no doubt have.
“But this is essentially about creation certain we are doing a best things opposite Nottinghamshire and that, as distant as possible, services are locally delivered to an concluded bargain of what best use is.
“The mutation of services is frequency only one large thespian closure.
“It’s thousands of people operative with adults to broach a best probable outcomes, and that’s what this is about.”