The NHS will be hit by a 'triple whammy' this winter, according to a report that warns the 'road to recovery will be long'.
Health bosses say the system will be left creaking from a surge in Covid-19 patients, alongside a 'huge' backlog of delayed treatment, as well as 'exhausted' staff battling against reduced capacity due to infection control measures.
The NHS Confederation, which represents the majority of hospital trusts, ambulance services, clinical commissioning groups and other healthcare providers in the UK, warned demand has 'outstripped' supply and that many doctors and nurses are already 'exhausted' by the pressures of this year, with no respite in sight.
It called on the Government to 'grasp the nettle' and invest in a fully integrated health and care system.
Its survey of 252 NHS leaders revealed nine in ten felt they did not have enough funding to hit their performance targets - or even upgrade buildings, IT and other infrastructure to improve services.
They warned the pandemic has set the health service back 'by years' in their report - titled NHS Reset - and urged ministers to 'lock in' changes made in response to the crisis that cut out 'needless bureaucracy' and snipped red tape.
Hospital trusts were ordered to get services back to 90 per cent of capacity by mid-October, but with staff absences due to testing problems and mounting demands as a 'double whammy' of coronavirus and flu hits A&E departments, bosses fear the ambitious goal will not be met.
The NHS receives funding through its 2018-signed five-year plan - at £20.5billion annually - but hospital leaders warned this budget needs to be expanded to help the health services 'play catch up' on appointments missed due to lockdown.
Boris Johnson has pledged an extra £3billion to the NHS for winter, which has been earmarked for maintaining Nightingale hospitals and increasing testing capacity.
The NHS Confederation urged the Government to 'grasp the nettle' and invest in a fully integrated health and care system. (Pictured: Ward on Liverpool hospital)
One in 50 NHS patients have now been waiting a year or more for planned surgery. The number of those waiting for elective ops for more than 18 weeks is at a 12-year high, with more than two million Britons now overdue
NHS surgeons are only working at around 50 per cent capacity in the wake of the Covid-19 pandemic, despite record numbers of people on the waiting list for routine treatment.
Professor Neil Mortensen, president of the the Royal College of Surgeons, revealed surgeons 'didn't have much to do' during the lockdown, as routine operations were cancelled to make room for an expected swarm of Covid-19 patients.
But they are struggling to get back to pre-coronavirus activity levels, despite barely any infected patients being in hospital. Surgeons say infection control measures and a lack of testing have left them unable to attack the backlog.
Professor Mortensen told The Telegraph: 'Most surgeons would say productivity is around half what it was before.'
He told the newspaper that there were obstacles in restoring services to levels seen before Covid-19, which experts say is needed to clear the backlog. Health bosses fear up to 10million patients will be left waiting for treatment by this winter.