Financial difficulties will force NHS services in England to undergo major reorganisations which could hit the poorest the hardest, MPs say.
The Public Accounts Committee said for hospitals this could mean services being closed or whole units merged.
The MPs said the difficulties were linked to historic debt, bad management and the current drive to make savings.
And they warned the changes had to be carefully managed by ministers or else patients would suffer.
Committee chairman Margaret Hodge said it remained unclear whether the problems many of these organisations were facing could be resolved without radical change.
“These trusts will be forced into reconfigurations or even mergers.
“This may deal with the financial challenges involved but could leave some deprived communities with unequal access to high quality healthcare when hospital departments are closed and services moved.
“London is in a particularly shocking state and nobody has got a grip on long-standing problems.”
Read more at BBC Health.