The number of patients who are forced to wait for more than four hours in accident and emergency departments before being treated has reached its highest level in a decade, a new report suggests.
In the last three months of 2012, 232,000 patients waited more than four hours in A&E - an increase of 38% over the previous quarter.
Experts at The King’s Fund said that between October and December the proportion of patients waiting more than four hours was at its highest level since 2003.
Researchers said that as financial pressures continued to “bite hard” on the health service there was growing pressure on emergency care.
So-called “trolley waits” - where patients who attend A&E and need to be admitted to hospital have to wait before they are given a bed - were also at their highest rate since the same period in 2003.
The latest report by the influential think tank suggests that health and social care providers are “pessimistic” about the financial outlook of their organisations and some are concerned that the quality of patient care has suffered as a result.
Two-thirds of 48 NHS finance directors and 58 directors of adult social care services surveyed said they were concerned about the financial outlook across the local health and social care system in 2013.
The NHS is in the middle of a £20 billion productivity challenge, while social care providers are struggling with tight budgets and growing numbers of people who need care.
A third of NHS finance directors said the quality of NHS care in their area had deteriorated over the past 12 months.
And half of social care directors said they thought the quality of services they commissioned had worsened in the past year, with a third fearing they would have to reduce services over the coming year.
“The NHS faces unprecedented financial pressures, and there are growing worries that patient care will suffer,” Professor John Appleby, chief economist at The King’s Fund said.
“For social care, it will be increasingly difficult for councils to make further savings without directly cutting services or affecting quality.
“Health and care services have coped well until now, but it is clear that many organisations expect things to become much more difficult over the coming year.”
Mike Farrar, NHS Confederation chief executive, said: “Despite huge efforts to maintain standards of care and finances, NHS leaders are increasingly concerned about the pressures mounting on their organisations and the knock on impact of reductions in funding for local government services.
“The findings of the Francis inquiry reinforce the fact that we must keep the focus on patients first and foremost.
“We need to look beyond short-term solutions that balance the books and examine how we can transform the way we deliver care so that it provides the best outcomes for people, in a way that is fully sustainable in the long-term.”
Labour’s shadow health secretary Andy Burnham said: “This survey provides clear evidence that England’s health and care system is heading in the wrong direction.
“Standards of care are deteriorating in many parts of the country as the NHS is dragged down by a toxic mix of cuts and re-organisation.
“England’s A&E departments are suffering their worst winter for a decade, with more people waiting longer than four hours to be seen or on trolleys in corridors.
“Ministers must urgently wake up to these warnings and ensure there are enough staff on the ground across the NHS to provide safe care.”
Health Minister Lord Howe said: “We have been absolutely clear that the NHS must find the efficiencies needed to deal with increased demand on the service without compromising on patient care and services.
“We expect the NHS to look seriously at how it can improve how care is provided, particularly to older patients and those with long term conditions.
“We also recognise that it is a challenging time for social care but the key must be to use existing resources more efficiently. Many local authorities are innovating and achieving much greater integration between health and care services, thereby improving care for people and making best use of available resources.”