MPs on an influential cross-party Commons committee have issued a stark warning over the likely effects of spending cuts on the NHS and social services.
And Conservative MP Stephen Dorrell, Chairman of the Health Select Committee, said the scale of NHS savings required over the next four years - estimated to be 4% annually - had never before been achieved.
In its report, the committee warned that the NHS and social services would be tested "to the limit" by the government's efficiency saving requirements. The spending review settlement represented a "significant challenge" for the health service, while there would be "an inevitable impact" on social care provision, it said.
It concluded that unprecedented levels of efficiencies would be needed to avoid cuts in services.
The committee was not convinced that present levels of social care could be maintained with the funding being made available.
The report said: "Unfortunately, we do not believe that the government is providing a clear enough narrative on its vision of how these savings are to be made."
A Department of Health spokesman said: ""Reform isn't an option, it's a necessity in order to sustain and improve our NHS. We have been clear that the NHS must cut back on bureaucracy, not on frontline care."