Some 85% of NHS trust leaders say they are more concerned about this winter than any previous one during their career.

The figure comes from a poll of health trust leaders for NHS Providers as waiting lists in England continue to reach record levels and cancer targets are routinely being missed.

Some 48% of trust leaders rated the quality of healthcare provided by their local area as very high or high, while just 30% predicted that it would reach that standard in two years’ time.

Nearly half (46%) strongly agreed or agreed they were on track to meet elective recovery and cancer targets by the end of the financial year.

And a further 27% neither agreed or disagreed, while a quarter (24%) disagreed or strongly disagreed they could hit the targets, which were put in place after the pandemic.

Saffron Cordery, the organisation’s interim chief executive, said: “Alarm bells should be ringing across Whitehall with warnings from our trust leaders that less than half now expect to meet key end of year elective recovery and cancer targets.”

Just 61.7% of people get cancer treatment within 62 days of an urgent cancer referral, compared with 77.2% before the COVID-19 pandemic.

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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, as more people need hospital care for respiratory conditions or problems made worse by cold weather and viruses.

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But many trust leaders told the survey that staff shortages, burnout, staff retention and staff absences are a major concern.

There are also continuing problems with ambulances queueing outside hospitals, due to a shortage of beds caused at least in part by issues discharging medically-fit patients into the community.

Ms Cordery said: “We can’t fix the serious knock-on effects caused by hospitals being unable to discharge thousands of patients who are well enough to recover at or closer to home – which in turn badly affects timely hospital admissions, including from A&E and the handover of patients from waiting ambulances – without addressing the long-standing challenges facing the social care sector.”

At the same time, a report from the Institute for Fiscal Studies has said that NHS spending is, in real terms, 12% above its 2019 level, yet the health service is getting fewer people off waiting lists.

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Max Warner, author of the report, said: “If either the NHS continues to fail to translate additional resources into additional activity, or numbers joining waiting lists return in anything like anticipated numbers, then waiting lists, and associated costs in terms of poor health and delayed treatment, will continue to grow for some time to come.”

An NHS spokeswoman said: “Despite concerns about what is likely to be a very challenging winter, the NHS is currently on track to deliver on its next recovery milestones.

“The NHS has already virtually eliminated two year waits for care and waits of more than 18 months are already down by 60% on last September.”

She said there was “no doubt the NHS is under considerable pressure” but said it is “preparing extensively and has already set out plans to manage additional demand, including through 24/7 control rooms, falls services and recruiting more call handlers”.

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