Managing financial pressures while also meeting the needs of an older population will be the NHS' biggest challenge over the next decade, its leaders have said.
A survey of NHS leaders, published after the NHS Confederation national conference on 20 June, showed 28% described the current financial position as "the worst they had ever experienced". An additional 46 per cent said it was "very serious".
Patient experience had been the most affected area according to 42% and 17% said availability of treatments had been hit the worst.
Mike Farrar, chief executive of the NHS Confederation, said despite efforts to maintain patient care standards healthcare leaders were "deeply concerned" about the storm clouds gathering.
He said: "They are cutting costs in the short-term but they know that much more radical solutions are the only answer in the long run.
"Frankly, without action on the way we provide health and social care, the NHS looks managing financial pressures while maintaining like a super-tanker heading for an iceberg. The danger is clearly in view and looming ever larger."
According to the results, providers of healthcare, such as NHS trusts, felt the pressure most strongly.
The most commonly cited priorities for improving the care quality in the next 12 months were; increasing the integration of care, as stated by 73%; and faster spread of innovation, said by 49%.
The Picker Institute Europe surveyed the chairs and chief executives of all its member organisations for the research.
