Measures to ease pressure on hard-pressed hospital accident and emergency departments are not working, MPs have warned, amid renewed concerns over the sustainability of NHS finances.
The Commons Public Accounts Committee said that radical change was needed to the way health care is provided in England - with more use of community and primary care services to reduce the strain on acute hospitals - if it was to be affordable in the long-term.
However, it said that the cash available for the upfront investment necessary to deliver the planned reforms was being eroded as increasing numbers of NHS bodies fell into deficit.
At the same time the committee warned that the current funding arrangements were acting as a "financial disincentive" for acute hospitals to shift more of the burden to community care.
"The different payment mechanisms and financial incentives for local health bodies are not aligned to encourage the sort of integration required to implement the proposed new models of care," the committee said.
"The current system of paying for emergency admissions hinders, rather than helps, secure the financial sustainability of NHS bodies."
The watchdog, Monitor, found that 80% of the foundation trusts involved in the provision of acute hospital services were reporting a deficit by the second quarter of 2014-15.
The committee said the NHS could struggle to achieve the efficiency savings it needed - which typically came in at 1% to 2% a year against a target of 4% - without a change of approach.
It also pointed to the high cost to the NHS of hiring temporary agency staff - which rose from £2.1 billion in 2012-13 to £2.6 billion in 2013-14 - with consultants said to be charging typically £1,760-a-day.
The committee chair, Margaret Hodge said: "From all our work across all of government, the fragility of the NHS finances causes me greatest concern.
"It is clear that the old ways will no longer work - radical change is required to make the NHS financially sustainable."
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