Concerns over the quality of health and social care are growing as the NHS continues to grapple with tightening budgets and rising demand, a survey of finance directors by The King's Fund suggests.
The survey, part of the King's Fund Quarterly Monitoring Report, found that a third of finance directors believe the quality of NHS care in their area has deteriorated over the past 12 months, compared with just about one in six in the previous survey, while almost half of directors of adult social services said the quality of services they commissioned had worsened.
According to the think tank, significant challenges currently being faced include meeting the 18-week referral-to-treatment goal as well as waiting times targets in accident and emergency (A&E) care.
The proportion of patients waiting longer than four hours in A&E departments is at its highest level for this quarter since 2003/4, and a quarter of all providers recording breaches of the target in the quarter to december 2012, it notes.
And on the financial side, while most NHS organisations are on track to meet targets pressures are growing. The report, which assesses how well the NHS is coping as it tries to achieve the £20-billion savings target on the one hand and incorporate healthcare reforms on the other, suggests the financial squeeze is beginning to "bite hard".
Two-thirds of NHS finance directors - up from around a half in the September 2012 survey - and nearly three-quarters of directors of adult social services are pessimistic about the financial outlook for 2013, and the service's ability to cope wit the rising pressures.
Mike Farrar, chief executive of the NHS Confederation, says the findings of the survey reinforce what its members have been saying for some time.
"Despite huge efforts to maintain standards of care and finances, NHS leaders are increasingly concerned about the pressures mounting on their organisations and the knock on impact of reductions in funding for local government services," he stressed.
"We need to look beyond short term solutions that balance the books and examine how we can transform the way we deliver care so that it provides the best outcomes for people, in a way that is fully sustainable in the long term", or the ability to maintain standards of care will be threatened.
According to farer, "for sustainable effective change, we must take the bull by the horns and produce whole-system solutions across the wider care system".
Shadow Health Secretary Andy Burnham said the survey "provides clear evidence that England’s health and care system is heading in the wrong direction".
"Standards of care are deteriorating in many parts of the country as the NHS is dragged down by a toxic mix of cuts and re-organisation," he noted, and warned of a "growing crisis in emergency care".
He called on ministers to "urgently wake up to these warnings and ensure there are enough staff on the ground across the NHS to provide safe care".