Some 85% of trusted NHS leaders say they are more worried about this winter than any previous winter during their career.
The figure comes from a survey of health trust leaders for NHS providers, as waiting lists in England continue to reach record levels and cancer targets are routinely missed.
Some 48% of trusted leaders rated the quality of healthcare provided by their local area as very high or high, while only 30% predicted it would reach that standard in two years.
Nearly half (46%) strongly agreed or agreed that they were on track to meet cancer and elective recovery goals by the end of the fiscal year.
And another 27% neither agreed nor disagreed, while a quarter (24%) disagreed or strongly disagreed that they could achieve the goals set after the pandemic.
Saffron Cordery, interim chief executive of the organisation, said: “Alarm bells should be ringing across Whitehall with warnings from our trusted leaders that less than half now expect to meet key year-end cancer and elective recovery targets. “.
Only 61.7% of people receive cancer treatment within 62 days of an urgent referral for cancer, compared to 77.2% before the COVID-19 pandemic.
In February, NHS England said the number should return to pre-pandemic levels by March next year.
Winter is naturally a more difficult time for the NHS, with more people needing hospital care for respiratory conditions or problems made worse by cold weather and viruses.
But many trusted leaders told the survey that staff shortages, burnout, staff retention and staff absences are a major concern.
There are also ongoing problems with ambulances queuing outside hospitals, due to bed shortages caused, at least in part, by problems discharging medically fit patients to the community.
Ms Cordery said: “We cannot fix the serious side effects caused by hospitals not being able to discharge thousands of patients who are well enough to recover at or closer to home, which in turn severely affects timely hospital admissions, including A&E.” and the transfer of patients from waiting ambulances, without addressing long-standing challenges facing the social care sector.”
At the same time, a report by the Institute for Fiscal Studies has said that NHS spending is, in real terms, 12% above its 2019 level, but the health service is taking fewer people off waiting lists. .
Max Warner, author of the report, said: “If the NHS continues to fail to translate additional resources into additional activity, or the numbers joining the waiting lists return to something close to the anticipated numbers, then the waiting lists and Associated costs in terms of poor health and delayed treatment will continue to grow for some time.
An NHS spokeswoman said: “Despite concerns about what is likely to be a very challenging winter, the NHS is currently on track to meet its next recovery milestones.”
“The NHS has already virtually eliminated two-year waits for care and waits of more than 18 months have already been reduced by 60% last September.”
She said “there is no doubt the NHS is under considerable pressure” but said it is “preparing extensively and has already put plans in place to manage additional demand, including through 24/7 control rooms.” days of the week, drop services, and recruiting more call handlers.”