The stand-in Health Secretary today issued a veiled threat to NHS managers - and said that central targets could be scrapped in a desperate bid to deal with waiting times.
In what may prove to be his only major speech before he is replaced next week, Tory Steve Barclay suggested the axe could fall on non-clinical staff amid demands for sweeping savings.
Mr Barclay announced that he had asked the Department of Health and Social Care (DHSC), NHS England and other "arms length organisations" to provide an organisational chart by the end of the month - in order to identify layers of management.
He told think tank Policy Exchange: "It will stimulate, I hope, a conversation within the NHS about how priorities and resources are being aligned."
Mr Barclay, who was appointed in early July following the mass walkout of Tory MPs which brought down Boris Johnson - claimed he had identified 53,000 staff across the health service "where the majority are not providing direct patient care".
He said he had imposed a recruitment freeze at DHSC, which has a £260 million payroll, and demanded 20% of savings across the department - with more to follow in coming years.
"Staff at the centre need to streamline the administrative burden of those on the front line and not risk adding to it," he said.
"If we are to reprioritise back office costs to the front line, there needs to be more transparency."
Meanwhile the Health Secretary said that the number of targets the NHS is expected to deliver should be scaled back - but failed to provide any specific examples which ones he intended to scrap.
"If everything's a priority, nothing's a priority," he stated.
Mr Barclay said he had held discussions with the Treasury about NHS pay amid concerns over staff retention, but said any decisions would fall to the next government after a new Prime Minister is appointed.
The Health Secretary also said that patients should be given the choice to travel further to access services that are not available in their area - but did not elaborate on how far they could go.
He said that tackling the shameful ambulance waiting times will be the "number one priority" in the winter.
Last week he was confronted by a heckler as he gave interviews outside a London hospital, who told him: "People are dying and you've done bugger all."
Referring to that exchange he told the think tank: "You will have seen this is not just my number one priority but from the recent viral video with my heckler that this is also a wider priority as well."
He claimed that a "small number of trusts" accounted for nearly half of ambulance handover delays, while also claiming: "We currently have over 12,000 beds occupied by patients who are medically fit to discharge."
