Fewer than half of NHS trusts will meet key recovery targets on waiting lists and cancer as services buckle under pressure, according to a new report.
A poll of health trust leaders for NHS Providers found nearly half (46%) 'strongly agreed' or 'agreed' they were on track to meet elective recovery and cancer targets by the end of the financial year.
A further 27% neither 'agreed' or 'disagreed', while a quarter (24%) 'disagreed' or 'strongly disagreed' they could hit the targets, which were put in place after the pandemic.
It comes as NHS waiting lists for treatment in England continue to reach record levels, with 7.1 million people on the overall waiting list and a raft of cancer targets routinely missed.
In February, NHS England said the number of people waiting more than 62 days from an urgent cancer referral to starting treatment should go back to pre-pandemic levels by March 2023.
At present, just 61.7% of people - the average for 2022/23 so far - get cancer treatment within 62 days, compared with 77.2% before the pandemic.
NHS England also set a goal to deliver around 30% more planned treatments by 2024/25 than before the pandemic, with over 10% more in 2022/23 alone.
However, the NHS is currently only hitting 96% of pre-pandemic levels in this area - the average figure for the first six months of this financial year.
For 2019/20 the monthly average was 1.36 million treatments started, and for 2022/23 so far it is 1.31 million.
By April 2023 the health service has also been told to eliminate waits of over 18 months - a target where there has been good progress.
According to a new NHS Providers report, trust leaders were more worried about this winter than any previous one, with nurse strikes and too few staff adding to the pressure.
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Some 85% of trust leaders 'agreed' or 'strongly agreed' they were more concerned about this winter than any previous one during their career, while only 6% disagreed.
The State of the Provider Sector 2022 report also found 89% of trust leaders were extremely concerned about the impact of winter pressures on their trust and local area.
Every year the NHS comes under pressure during the colder months as emergency admissions rise, with more people requiring hospital care for respiratory conditions or problems made worse by cold weather and viruses.
But many trust leaders said this winter they were especially worried about staff shortages, burnout, retaining existing workers and staff absences.
Almost four in five trust leaders (77%) said they were 'very worried' or 'worried' about their trust having the right numbers, quality and mix of staff to deliver high quality care.
Meanwhile, 86% were 'very worried' or 'worried' about having the capacity to meet demand for services over the next 12 months.
Asked what the biggest risks were to services, leaders cited several reasons, including a winter strike by the Royal College of Nursing (RCN) as well as the recruitment, retention and morale of staff.
Speaking at the start of the NHS Providers conference, Saffron Cordery, its interim chief executive, said: "Our staff have worked incredibly hard to bear down on care backlogs, virtually eliminating two year waits and making real strides on other long delays.
"But this progress could be thrown off track with patients waiting even longer than they are currently because of the myriad pressures services face.
"Alarm bells should be ringing across Whitehall with warnings from our trust leaders that less than half now expect to meet key end of year elective recovery and cancer targets."
Ms Cordery said NHS trusts are prepared for strike action "but the NHS is struggling already with severe staff shortages and ever-increasing workloads".
She added: "We know what nurses and so many other NHS workers are going through, faced with below-inflation pay awards.
"With a staggering 132,000 vacancies across trusts, mounting workloads and the soaring cost of living have dented morale and make it harder for trusts to recruit and retain staff.
"And we can’t fix the serious knock-on effects caused by hospitals being unable to discharge thousands of patients who are well enough to recover at or closer to home - which in turn badly affects timely hospital admissions including from A&E and the handover of patients from waiting ambulances - without addressing the long-standing challenges facing the social care sector."
A new report from the Institute for Fiscal Studies (IFS) said the NHS needs to "ramp up" treatment volumes if waiting lists are to start falling any time soon.
It has previously said the NHS waiting list in England could peak at well above eight million and will not begin to fall until late 2023.
Max Warner, author of the report, said NHS spending in England is, in real terms, 12% above its 2019 level, yet the health service is getting fewer people off waiting lists.
He said: "If either the NHS continues to fail to translate additional resources into additional activity, or numbers joining waiting lists return in anything like anticipated numbers, then waiting lists, and associated costs in terms of poor health and delayed treatment, will continue to grow for some time to come."
An NHS spokeswoman said: "Despite concerns about what is likely to be a very challenging winter, the NHS is currently on track to deliver on its next recovery milestones.
"The NHS has already virtually eliminated two year waits for care and waits of more than 18 months are already down by 60% on last September.”
She added there was "no doubt the NHS is under considerable pressure" but said it is "preparing extensively and has already set out plans to manage additional demand, including through 24/7 control rooms, falls services and recruiting more call handlers".