The Government has been warned it risks failing to meet a key pledge on waiting times as a new survey showed most trust chief executives and chairmen believe the NHS is facing a "very, very" serious financial situation.
A poll has shown 42% of NHS chairmen and chief executives in England consider the financial situation facing their organisation to be the "worst they had ever experienced" with a further 47% saying that it was "very serious".
The NHS Confederation poll showed 70% believed money pressures would get worse over the next year, with 67% predicting a deteriorating financial situation over the next three years.
Three-quarters (75%) said they believed that cuts to local authority budgets would have an impact upon their organisation's services in the next 12 months. The survey showed 53% believed that patient access - largely waiting times for patients - would get worse over the next 12 months while just 21% thought it would improve.
A majority (58%) said they felt the quality of the services they delivered or commissioned would improve over the next 12 months but one in five (20%) said they felt that quality would get worse during this time.
The online survey conducted between May and June found 50% thought that patient safety would improve over the next year, but 10% thought it would get worse.
The survey received responses from 287 chairmen and chief executives of organisations including hospital trusts, primary care trusts, ambulance and mental health trusts and private providers to the NHS.
Health Secretary Andrew Lansley said: "It is good to see the NHS Confederation wants to focus on quality. We also agree NHS leaders should have the freedom from political interference to innovate from within and challenge the outdated structures they know exist at the moment. Our modernisation plans give them the freedom to do just that.
"While access to NHS services remains good and waiting times have remained stable, thanks to the hard work of NHS staff, the NHS Confederation has raised concerns about pressures increasing in the future. That is why we have pledged to keep waiting times low and make an extra £2 billion available by 2014 to support social care."
Shadow Health Secretary John Healey said: "This is further evidence of widespread anxiety in the health service, as financial pressures impact on patient care and we start to see the NHS going backwards again under the Tories. Meanwhile David Cameron and his ministers are carrying on as if everything's fine, pushing ahead with their huge and reckless top-down reorganisation and showing they are out of touch with the concerns of nurses, doctors and NHS leaders."