Simon Stevens, the new chief executive of NHS England, says the service needs to return to treating more patients in their local communities, and learn from countries such as Sweden, Holland and the USA to bolster care around small hospitals.

Speaking to the Daily Telegraph ahead of a major speech to the NHS Confederation’s conference in Liverpool on Wednesday, he said that most of western Europe has hospitals which are able to serve their local communities, “without everything having to be centralised”. He added that the service needs to abandon a fixation with “mass centralisation” and instead invest in community services to care for the elderly.

Mr Stevens told the newspaper that “the single most important question facing us is how do we best support older people? Two-thirds of hospital patients are over retirement age.” However, “you cannot have a modern health service that is not treating older patients with dignity and compassion, supporting them at home and ensuring targeted prevention”.

He argues that the system of care outside hospitals is too complex, with too much duplication and too many gaps for patients to fall through, he suggests. “There is a big opportunity to reorganise that so it meets the needs of those at home. At the moment it is too complicated and too fragmented. If you were starting from scratch you would not design community services like that.”

He also called on businesses in the UK to financially reward employees for losing weight and adopting healthy lifestyles, citing an example of when he lived in the USA. Mr Stevens added that the NHS could also learn from the way the US had introduced electronic hospital records, which had been a “huge misfire” in the UK.