There are ‘huge pressures' on NHS finances with a quarter of NHS trust finance directors expecting to overspend their budgets this year, according to the latest quarterly monitoring report from The King's Fund.
Analysis of the data collected for the report shows that the nursing workforce increased by almost 9,000 over the past six months to nearly 315,000 - the highest on record.
The King's Fund said this underlines the difficult choice facing hospitals: whether to balance the books or maintain quality of services, with many choosing to recruit more nurses despite their budgets being stretched to the limit.
The report warns that cracks are beginning to appear in NHS performance as a result of the growing financial pressures and rising demand for services.
Although the A&E waiting time target was just met over the quarter (April - June) once all types of unit are included, hospitals with major A&E departments have now missed the target for 51 weeks in a row.
Meanwhile, more than 3 million people had been waiting at least 18 weeks for hospital treatment at the end of the quarter, the highest number since 2008.
Additionally, the number of patients waiting more than six weeks for diagnostic tests stood at more than 18,600 at the end of May 2014, an increase of nearly 12,000 on the same month last year.
John Appleby, chief economist at The King's Fund, said: ‘Our latest quarterly report paints a picture of a service under huge pressure, with cracks beginning to appear in NHS performance. It once again underlines the need for new funding if services are to be maintained.
"The increase in the nursing workforce signals a very welcome commitment to improving care, although it remains to be seen whether hospitals will be able to sustain current staffing levels when money becomes tighter later in the year. The disparity in the plans of providers and commissioners points to a worrying mismatch between activity and funding, which could have serious financial consequences."
Dr Mark Porter, chair of BMA Council, said:"This report paints a stark picture of an NHS under extreme financial pressure.
"Rising waiting times point to a system which is struggling to keep up with demand. The NHS has now endured several years of under-investment and the system is starting to buckle. Growing queues in our GP surgeries and emergency departments are the daily reality for many patients now."
He added:"We cannot continue to meet rising demand on our NHS with under-funding, without the quality of patient care being affected.
"The BMA has criticised the move from planned services to a market economy in healthcare. This report demonstrates the disconnect between those commissioning services and those delivering them, leaving the NHS - and ultimately patients - vulnerable to the effect of large gaps opening up access to services."
