The outgoing boss of the NHS in England has warned that the organisation is need of billions of pounds of extra funding in order to push through "painful and unprecedented" changes in the next parliament.
In an interview with The Guardian, Sir David Nicholson - who steps down at the end of the month - said that without the money the NHS will struggle to survive on recent austerity-driven budgets.
Sir David is calling for a "change fund" on top of the health service's annual £110 billion budget to help pay for its reformation.
The industry-wide changes required would be "huge, massive (and) unprecedented", he said, and would be "painful for staff" and difficult for the public to accept.
But without them future NHS leaders would preside over a "managed decline".
The outgoing head of the NHS has come under fire after posting a spoof video mocking a senior colleague and Health Secretary Jeremy Hunt.Read the full story ›
Hospital bosses deserve high pay because their jobs are so difficult, the head of the NHS has said.
Sir David Nicholson defended salaries that can top £200,000 a year and urged people to stop "denigrating" health service managers.
Sir David was asked about remarks made by outgoing NHS England medical director Sir Bruce Keogh, who suggested significant salaries were needed to attract managers of "the right calibre".
He declined to endorse Sir Bruce's words, but stressed that the health service was going through "transformational change" and required "top-drawer people".
Sir David - whose own salary is more than £210,000 - made clear that the overall NHS pay bill had to be kept under control amid huge financial pressures, but he said it was wrong to scapegoat those earning large sums.
"If you constantly denigrate and criticise them, it's hardly surprising that they respond to that," Sir David said.
"They absolutely are highly paid jobs... They are amongst the most complex and difficult jobs in the world.
"Those chief executive jobs, the complexity of those are on a scale managerially that most of us would have difficulty to understand."
Sir David Nicholson will face a fresh grilling from MPs today over the use of so-called gagging clauses in the health service.
The outgoing NHS chief executive will again appear before the Public Accounts Committee to answer questions about millions of pounds in secret pay-offs for departing staff.
It is the third time in a matter of months that Sir David has been summoned before the influential watchdog, and the session is expected to be stormy.
More than 600 special severance payments were agreed in the health service between 2008 and 2011, costing the public purse over £15 million.
Outgoing NHS boss Sir David Nicholson has attacked the media for a "lack of balance" when reporting about the health service.
Nicholson, who came under intense scrutiny over the report into the failings of the Mid Staffordshire NHS Trust, said the press and social media needed to find a "better way" to report what is going on in the health service in an article posted on the NHS England website:
"The thing that characterises the views and comments for me is the lack of balance. For example, this time last year, in the wake of the Olympic opening ceremony, there was an outpouring of praise for the NHS. It was almost as if support for it had become close to being a religion.
"Read the newspapers over the last few weeks and it appears the NHS has become one of the worst healthcare systems in the world. In truth, neither of these two things are true, and this is the dilemma."
Nicholson recently announced his intention to retire next year, citing the fact he had become "part of the story" as a contributing factor in his decision.
NHS chief Sir David Nicholson was roundly criticised by MPs today for misleading them over the extent of pay-offs to prevent "whistleblowers" speaking out about concerns over patient safety.
He is accused of not telling them that the NHS had spent more than £2 million on gagging orders for former employees since 2008 - a figure revealed by a Freedom of Information request.
Sir David angrily denied staging a cover-up when he appeared before the Commons Public Accounts Committee.
ITV News' Deputy Political Editor Chris Ship reports:
The head of the NHS in England has strongly denied staging a "cover-up" over the use of gagging orders to prevent staff speaking out about conditions in hospitals.
Appearing before the Commons Public Accounts Committee, Sir David Nicholson angrily denounced the claims made by Tory committee member Stephen Barclay as "erroneous and wrong".
Sir David - who is leaving after strong criticism over his role in the Mid Staffs NHS trust scandal - told the committee that he had always acted to support whistleblowers in the NHS.
"I can absolutely refute that I have ever been involved in any kind of cover-up in relation to the expenditure that's identified. I have been absolutely honest and truthful with this committee," he said.
He added: "I have always supported people who have stood out against the system. It is a very, very important part of being a health professional and being a leader in the NHS..."
Health Minister Norman Lamb has told ITV Daybreak that he was "horrified" by the revelation that the NHS spent £2 million on more than 50 gagging orders.
Tory MP Steve Barclay has today called for Sir David Nicholson, chief executive of NHS England, to stand down following the news.
Mr Lamb said: "[Sir David Nicholson] should be accountable for what he said. People have to answerable for their actions."
"I had a sense that it happens too much, but it shouldn't happen at all. It's scandalous."
Read more: NHS spends £2m to stop staff speaking out
Speaking about the revelations that the NHS spent £2 million on more than 50 gagging orders, Conservative MP Steve Barclay - who is calling for NHS boss Sir David Nicholson to resign - said: "A lot of money seems to have been wasted silencing the very people we want to speak out."
Read more: NHS spends £2m to stop staff speaking out