John Appleby, chief economist at The King’s Fund, also warned services in some hospitals could seriously deteriorate due to the impact of the economic crisis.
He said it was highly unlikely the NHS budget would be significantly increased in the foreseeable future.
Against this grim financial background managers are being asked to get 5p more value from every £1 they spend, every year, partially to keep up with the increasing demands of an ageing population.
Patients have already experienced the effect of this. For example, nine in 10 trusts have introduced tighter criteria to qualify for a range of procedures deemed to be of ‘low clinical value’ - including hip and knee replacements, cataract removals and weight-loss surgery.
Doctors and patient groups have argued that these are unfair and will be more expensive in the long run.
But Prof Appleby said the “financial imperative” was so pressing that such restrictions were likely to continue well beyond 2015.
He said: “In terms of disinvesting from comparatively low value treatments, I would expect that to go on, even though it’s extremely difficult if it’s a case of withdrawing a service.”
However, he questioned how much impact limiting access to such procedures actually had on improving the finances of primary care trusts (PCTs), which pay for treatments in hospitals.
And he said the NHS needed to make “a quantum leap” to keep raising productivity year after year, to save a cumulative total of £50 billion by 2020.
Restricting some operations, plus “shaving a bit off the length of stay in hospitals and changing to low energy lightbulbs isn’t going to do it”.
Politicians had to grasp the nettle and tackle more fundamental questions, he said, such as the fact that there were “too many hospitals in the wrong places”.
“The system of care is not as good as it could be if we reorganised it,” he said.
Earlier this week, The Daily Telegraph disclosed that South London Healthcare NHS Trust, which runs three hospitals, was on the brink of bankruptcy and could soon be run by a management team appointed by ministers. Exactly what will then happen to it is unclear.
But senior figures say this is not an isolated example, and there are many other hospital trusts in dire financial problems, particularly in outer London and the south east, that could go the same way.
Asked if closures were inevitable, Prof Appleby said: “In a word, yes.”
Whole hospitals could close, he said, “or relatively small district general hospitals could attempt to withdraw from providing the full range of services and become more specialist”.
In the meantime there was the danger of a poorer and poorer service in underperforming hospitals, he warned.
“I think the worry with that is that there will be certain areas that would start to see deterioration of services to such a degree that the Care Quality Commission has to step in.”
The CQC has the power to close down wards or services until the provider meets safety standards, and can even close them down permanently.
Prof Appleby said: “That’s really serious: it’s patients having to be ferried to other areas.
“If the NHS got to that stage it would be really appalling.”
Earlier this month Mike Farrar, chief executive of the NHS Confederation, warned that without “assertive action”, “the NHS looks like a supertanker heading for an iceberg”.
A Department of Health spokesperson said: "We know the NHS can, and must be, more efficient to meet future challenges. Where the NHS can do things better and save money to reinvest in high quality patient care, it must do so. We have always been absolutely clear that being efficient does not mean cutting services — it means getting the best services to meet patients' needs and the best value for every pound the NHS spends."
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