By Nick Triggle
Health reporter, BBC News
Hospital closures are inevitable, many believe
Politicians are "not being open and honest" about the issue of hospital closures, a coalition of charities and patient groups says.
Jeremy Taylor, head of National Voices, said the parties were happy to talk about the need for savings and moving care into the community.
But he said they were "shying away" from the flip-side - services closing and even whole hospitals shutting down.
All the main parties claimed they had clear policies to tackle the issue.
Mr Taylor said his organisation did not oppose hospital reorganisation and in many cases it can make sense medically.
He said minor surgery and treatments for conditions such as asthma, diabetes and heart disease could often be done in GP practices.
Giving older people more support in their home to prevent falls or emergency admissions for their illnesses could also keep patients out of hospital, he added.
"Quite often people prefer this and it makes sense both financially and clinically, but it does mean wards and beds going and even whole district general hospitals closing.
"But that is a taboo subject. Politicians don't want to talk about it in the election and I don't think that is fair. If the reasons for the changes are set out I think the public can understand it and be convinced.
"But MPs have to treat us like grown-ups."
Hospital reorganisation is already well under way. A&E and maternity services have been closed or earmarked for closure in a variety of places across the UK, including London, Greater Manchester and towns such as Blackburn and Burnley.
But Mr Taylor believes this is just the start as the health service prepares for the spending squeeze.
The NHS has been told to make between £15bn and £20bn of savings from 2011 to 2014.
Mr Taylor said: "It is clear we are going to see many more hospital reorganisations, but no-one is explaining why. You often find MPs going back to their constituencies and campaigning against closures, leaving it to local health managers to face the anger of residents."
Nigel Edwards, the policy director of the NHS Confederation, which represents managers, agreed more cuts were on the way.
"The NHS has to make some tough decisions about how it organises its services over the next five to 10 years.
"We will need to significantly rationalise services so we can cut costs and in many cases offer better care."
The British Medical Association said it too would like more openness.
But a spokesman warned: "There is a crucial distinction to be made between reconfiguring services for clinical reasons - for example developments in keyhole surgery may mean patients do not need to stay overnight in hospital - and cutting them for financial reasons."
All three parties have said they are not against hospital reorganisation in principle and claimed their policies are clear.
A Labour party spokeswoman said: "Where there is a strong clinical case that changes to services will make improvements and save lives, we will back local NHS clinicians in making them.
"Where changes are not locally led and clinically justified, we will not support them."
The Tories have promised a moratorium on hospital changes if they win power, so that existing decisions can be reviewed.
A spokesman for shadow health secretary Andrew Lansley said the party was not opposed to changes, but said the decisions made so far had been "misguided and based on flawed analysis".
Meanwhile, the Liberal Democrats said they would back decisions that had been led by doctors and allowed local people a "direct say", which they said was not always happening currently.