The NHS is entering a period of significant risk that could jeopardise the progress made over the past decade, according to the King’s Fund.

Halfway through the coalition government’s term of office, a new report by the health policy think-tank the King’s Fund finds that NHS performance is continuing to hold up well.But it warns that as unprecedented financial pressures start to bite, cracks are beginning to appear, with accident and emergency waits rising and more hospitals in financial difficulty.

Major organisational changes and the loss of experienced managers leaving the service are also leaving the NHS in a precarious position, it says. This comes after the coalition government enacted major reforms of the NHS in April, which will see PCTs and SHAs abolished by the spring, to be replaced by groups of Clinical Commissioning Groups, which are led by family doctors.

A number of groups, such as the British Medical Association, and tentatively the King’s Fund, have said the NHS reform was distracting the health service from its real purpose: to increase efficiencies and save £20 billion by 2015.

The report also identifies several long-standing challenges that were highlighted in the King’s Fund’s previous review of NHS performance between 1997 and 2010.

These challenges include tackling health inequalities and improving patient experience. The report finds that it is too early to judge the impact of the coalition’s policies in these areas, as much of the underlying data is in-line with previous trends or is not yet available for the current year.

But it does praise the effort of the government, which has seen greater than £10 billion of planned efficiency savings being delivered through the QIPP savings scheme.

However, the report points out that there are still important areas where progress is needed. This includes both the rise in A&E waiting times, and in emergency admissions for people with long-term conditions, and in emergency bed days among the over-65s.

The report also examines the coalition’s recent reforms and their greater emphasis on outcomes, transparency, competition, and commissioning. It finds that the shift from targets and performance management under the last government has been gradual, with much of the previous system still in place.

Overall, the report concludes that more time will be needed to judge the impact of the reforms on NHS performance.

Anna Dixon, director of policy at the King’s Fund, said: “The NHS is continuing to perform well but there are treacherous waters ahead. There are huge risks, particularly in ensuring that quality of care does not suffer with the further financial squeeze. The stakes for patients could not be higher, and front-line leaders will have a crucial role to play in meeting the challenges ahead. Neither competition nor commissioning reform alone can be relied on to make the improvements needed. Fundamental change will be required to address the challenges of the future as the population ages and health needs change.”