Video report by ITV News Correspondent Juliet Bremner
The NHS is close to breaking point and hospitals will have to make "unpalatable" decisions about care levels and jobs, unless the they receives more funding, the head of one of the service's largest trade bodies has warned.
In a number of media appearances on Sunday, Chris Hopson, the head of NHS Providers, warned that without further funding the NHS would need to consider greater rationing of care, staff layoffs and a relaxing of targets.
Writing in The Observer, he said the health service was "increasingly failing to do the job it wants to do, and the public needs it to do, through no fault of its own", and said there was a need for "an open, honest, realistic, national debate on what gives" if no more money is made available.
NHS services are already showing the strain - Mr Hopson's warning comes after ambulance response targets were missed for the 14th month in a row, according to figures from NHS England.
Meanwhile, 80% of England's acute hospitals are in financial deficit.
Speaking on The BBC's Andrew Marr show, Mr Hopson said the NHS was "under the greatest pressure we have been for a generation" and warned that the health service is "really struggling to make the money work" and warned of a "huge gap coming".
Mr Hopson pointed to the fact that this year NHS funding increased by 3.8%, but will increase by 1.4% next year, 0.3% the year after, and 0.7% the year after that, while the cost and demand of the NHS rises by 4% each year.
The pressure on funding means that it is "impossible to deliver it [a seven-day NHS] on the current level of staff and the current money we have available", Mr Hopson told The Andrew Marr show.
He continued: "Something has to give ... it can't cover important new policies like seven-day services."
He finished by saying that currently the NHS is "being asked to deliver the impossible and then being chastised when it inevitably falls short".
Mr Hopson's warning comes ahead of the Chancellor's Autumn Statement due in November, and just days before the Commons Health Select Committee grills NHS England directors and health minister Philip Dunne over the state of the health service.
His comments also sit against a background of week-long walkouts planned by junior doctors in October, November and December in protest over new contracts, protests that Mr Hopson believes are a result of the "pressure" they are under.
In his Obsever article, Mr Hopson said that "thanks to the dedication of staff, NHS performance rarely goes off the edge of a cliff" but that a lack of funding meant a steady decline had set in.
"[NHS] Trusts will, of course, do all they can to deliver efficiency savings and productivity improvements," he wrote.
"But they are now saying it is impossible to provide the right quality of service and meet performance targets on the funding available."
A spokesman for the Department of Health was quoted by the newspaper as saying: "We know the NHS is under pressure because of our ageing population, but we rightly expect the service to continue to ensure that patients get treated quickly."