NHS Providers’ annual survey of 185 trust bosses found 78% fear not having enough capacity to meet demand.
Almost nine in 10 worry social care does not get enough investment and fewer than one in three thought they could provide high-quality care in the next two years.
The membership body said the health service was facing its “toughest test yet”.
The warning came after the waiting list for planned appointments and procedures grew to a record 7.77 million in September.
Sir Julian Hartley, NHS Providers chief executive, said: “Rishi Sunak’s pledge to cut waiting lists is going to be increasingly difficult to achieve. We’re really hoping we don’t see any more strike action, but we don’t know where the talks are at. There could well be more strikes and, if there are, I think that really will put paid to the delivery of that pledge.”
The poll also found fewer than half of trust bosses thought the quality of care on offer was high – with just 1% ranking it very high and 40% high while 49% rated it average and 5% low.
One NHS trust leader said there was “clearly a huge amount of variability within care at the moment and I think, unfortunately, that variability is only increasing”.
An NHS spokesperson said strikes “created unavoidable financial costs” but insisted the health service was making progress with recovery plans and delivering record numbers of diagnostic tests and checks.
Meanwhile, the NHS will trial the use of artificial intelligence to tackle hospital admissions.
Four GP practices in Somerset are trying out a system that highlights patients with complex health needs who are at risk.
More support will be put into place to help prevent illness.
In Buckinghamshire, electronic sensors on kettles and fridges will spot changes in patients’ eating and drinking habits.
And teams in Birmingham will use an algorithm to predict the top 5% at risk of needing hospital treatment so staff can offer extra assessments and medicine reviews.
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NHS chief executive Amanda Pritchard said: “This suite of tech and data solutions ahead of winter demonstrates how NHS staff across the country are innovating every step of the way, maximising the use of the latest technology and AI to help patients but also significantly reducing the number of avoidable A&E attendances.
“Not only are these measures better for patients who can be cared for at home, where they feel most comfortable, but they are good for the NHS too, particularly when we know that this winter is likely to be incredibly challenging.
“Staff are already feeling the pressure with record demand for A&E and ambulance services.
“These innovations are an extra and welcome addition to our winter toolkit, with more call handlers and more beds already in place.”
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