NHS managers are worried about the quality of patient care and many believe Prime Minister Rishi Sunak’s commitment to cut waiting lists will be difficult to achieve, according to a new report.

A poll of NHS trust managers and chief executives found that fewer than half think the quality of care on offer in the health service is high, with 1% ranking it very high (1%) or high (40%), while 49% rated it as average and 5% low quality.

This 41% figure has dropped from 48% last year, and is lower than before the pandemic.

Looking to the future, leaders expect the quality of care to drop further, with 27% predicting the quality of healthcare provided by their local area in the coming year will be high, 57% saying it will be average and 10% low quality.

Most leaders (95%) surveyed by NHS Providers are also concerned about how the NHS will get through winter, with 80% expecting this year to be tougher than the last.

Rishi Sunak’s pledge to cut waiting lists is going to be increasingly difficult to achieve

Asked about their biggest concern in relation to trust’s finances over the next 12 months, leaders said further strikes, followed by the impact of inflation.

Meanwhile, 82% strongly agreed and a further 18% agreed that “continued industrial action over 2023/24 will compromise the NHS’s ability to deliver national recovery targets for elective and urgent and emergency care”.

It comes after the NHS waiting list in England hit a record high of 7.77 million and it emerged that hospitals will be allowed to cut back on pre-planned care to help cover the cost of previous strikes, which is thought to be around £1 billion.

In a letter to health leaders, NHS England said the “elective recovery target” – the ambitions for cutting the waiting list – will be “reduced” for the rest of the financial year.

It also asked local leaders to come up with new plans “reflecting the impact of the reduced elective activity goal”.

Sir Julian Hartley, chief executive of NHS Providers, 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.”

He said the reduction of national average targets for planned care from 105% to 103% “is likely to mean a slowing down of elective activity but we’ve yet to see how that will play out.

“Everything is pointing to making that commitment from the Prime Minister around the size of the waiting list, particularly given it stands now at nearly 7.8 million, really difficult to achieve.”

I do think there's a sense of dread of strike action being revived as we head into this winter period

Sir Julian said a “major fear” in the health service is more strikes, adding that the last round of action was co-ordinated between juniors and consultants, “which did have a significant impact on planned activity but also put huge pressure on urgent and emergency care”.

He added: “The provision of a Christmas Day service when patients are still coming in large numbers through emergency departments and the urgent care system adds enormous extra strain…

“I do think there’s a sense of dread of strike action being revived as we head into this winter period.

“What we saw last winter was pretty extraordinary, certainly in my experience of running hospitals. If we get more strike action, if we see a repeat of some of that, I think that’s a big risk.

“The NHS can’t afford further strikes. Talks between the Government and doctors’ union are promising and it’s absolutely vital that ministers pull every lever they can to break the deadlock.”

The new poll also found that most trust leaders a(78%) are very worried or worried about whether their trust has capacity to meet demand for services over the next 12 months, a higher proportion than before the pandemic (61%).

One NHS leader said a real strength of the NHS is its availability for people who need to be seen “but not everyone is seen in a timely way and and the reality is not every patient would receive the level of care that we would want for them”.

They added there is “clearly a huge amount of variability within care at the moment and I think, unfortunately, that variability is only increasing.”

When it comes to staff, most trust leaders surveyed are extremely or moderately concerned about the current level of burnout (84%) and morale (83%) across the workforce.

Some 89% of trust leaders are also very worried or worried about whether sufficient national investment is being made in social care.

Overall, 185 NHS leaders from 118 trusts responded to the survey, representing around half of providers.

NHS Providers said there are currently 125,000 vacancies in the NHS in England.

An NHS spokesperson said: “Recent data makes clear the pressure the NHS is under as we head into what is expected to be another challenging winter – more than two million people attended A&Es last month making it the busiest October on record, alongside the highest number of emergency admissions since January 2020, and the busiest month this year for the most serious ambulance call-outs.

“Despite ongoing pressures, including over 10 months of strikes, the NHS has made significant progress on its three recovery plans thanks to the incredible efforts of staff, who are seeing and treating many more people than pre-pandemic – delivering record numbers of diagnostic tests and checks, treating more people for cancer at an earlier stage, and completing thousands more routine procedures, with the number of waits over 65 weeks more than halved since their peak in June 2021.

“Disruption due to strike action has had a significant impact on patients and staff, and created unavoidable financial costs – that is why the NHS has set out actions for local areas to take to protect patient safety and prioritise urgent and emergency services so that patients receive the best possible care this winter, while the primary focus for routine activity should be on long waits as well as urgent elective and cancer care.”