The NHS should gear itself up to push the case for overhauling hospital care, the head of the health service says. NHS chief executive David Nicholson said deficits had poisoned the debate. But he told the BBC News website managers and doctors had an opportunity to convince the public of the need for change now the problems had eased.

It comes as proposals are being put forward in all 10 English NHS regions to strip hospitals of key services in a bid to create super "regional" centres. Strategic health authorities, which oversee local NHS services, were told at the beginning of this year to publish details of the so-called reconfiguration plans being put forward.

An analysis of this data, shows there are 28 consultations in the pipeline or already completed affecting hospital services.

These involved everything from closing A&E departments and downgrading maternity units to centralising specialist services such as paediatrics and heart care.

The government has argued that advances in medical technology and restrictions in working hours under EU rules mean that the NHS will have to centralise specialist services in return for providing better care. This will lead to a whole host of district general hospitals being downgraded - and some suggest even closed - while community services are beefed up. The data from the SHAs is in some cases a few months old and each area has interpreted the Department of Health directive - made in a bid to make the reconfiguration process more "open and transparent" - differently.

Changes But what it does show is that the changes are being felt in every corner of the country.

Mr Nicholson acknowledged some NHS trusts had felt inhibited in debating the changes because deficits had been "poisoning" the debate. But after forecasts last month showed the NHS was due to finish £900m in surplus this year with just a handful of trusts struggling to balance the books, he said it was much more "straightforward" for the NHS to put the case. "The context now we're operating in is completely different in which we were 12 months ago and I think that does open up a whole new set of opportunities for our relationship with general public."

He said he expected managers and doctors to "actively go out there and engage the public". Although he said this would not represent an acceleration of the process.

His intervention comes as the Royal College of Surgeons have criticised the government for a "lack of political will and central direction" over reconfiguration.

The college believes there should be between 12 to 16 major trauma centres - at the moment trauma care is carried out by most of the 200 plus hospital trusts.

But Katherine Murphy, of the Patients Association, said she was wary about how the NHS will respond. "As with all changes, patients are the last to be consulted.

These changes are some of the biggest the NHS has ever faced, but to date all we have had is tokenism.

"Patients have a right to be properly consulted on. We are not saying we are against change, in some respects it will be needed, but I do think we should slow down and take stock of what we need."