Healthcare in England is stuck in a "messy no man's land" because of the "deeply confusing" way in which it is organised, a former health secretary has warned.
Power splits in health and social services mean there is a "profound misalignment" in the "direction of travel" of care provision locally and national controls, Alan Milburn said.
A report by consultants PwC, which he helped to write, said many of the functions carried out by the clashing organisations could be gradually merged.
He told the BBC Radio 4 Today programme: "One government agency, the CQC, can turn up at a hospital one day and say 'increase the number of nurses on wards'; the next day another government agency, NHS Improvement, can turn up and say 'reduce your staffing costs rather than increase them'.
"Now that is a recipe for confusion. Right now we are in a messy no man's land, stuck somewhere between national control and local control, and that will not deliver what the Government really wants."
The "big bang" of health reforms brought in under the last government by then health secretary Andrew Lansley was a "spectacular failure", the former Labour Cabinet minister said.
Warning that the "current structure isn't working", he called for radical reforms introduced in Greater Manchester, which became the first English region to gain control of its health spending, to be more widely adopted.
"Services are delivered on the ground, patients are treated on the ground - that is where power should be located."