The findings show how years of squeezed funding, major workforce challenges and rising demand on hospitals and ambulance services have taken their toll, with overstretched community and mental health teams also coming under increasing strain.

However, the survey shows a keen determination by health leaders to keep improving patient care, and clear backing for the government's plans to shift care out of hospitals to community-based services. There are also signs that concerns about staff burnout and morale, although still a major worry for trust leaders, are starting to come down from very high levels recorded in recent years.

The survey findings include:

• 96% of trust leaders raised concerns about the impact of seasonal pressures over winter on their trust and local area.

• Delayed discharge (57%), social care capacity (49%) and acute bed capacity (43%) were identified as the top three greatest risks to the provision of high-quality patient care over winter.

• 71% of trust leaders and 100% of acute specialist trust and ambulance trust respondents thought it unlikely the NHS can meet the constitutional standards over the next five years.

• 79% of trust leaders were very worried or worried about whether their trusts have capacity to meet demand for services over the next 12 months.

• 98% of trust leaders expressed support for the national policy agenda to shift more care from acute services to community and move care closer to home for patients.

• When considering how patient care could be improved, the top three areas trust leaders would like the new government to prioritise are capital investment in estates (54%), capital investment in digital (48%) and social care (41%).

Saffron Cordery, deputy chief executive of NHS Providers, said: ‘The NHS has had its busiest ever summer and won't get a moment's respite as it heads into another gruelling winter.

'Despite this, trust leaders know the health service needs to work differently to improve care for patients. And, with a significant - and welcome - boost for the NHS in the Budget, they are fully aware the health service needs to provide more bang for the buck, too. They are working flat out to improve services, reduce waiting lists, and see patients as quickly as possible.'

In response to the report, executive director of RCN England Patricia Marquis, said: ‘A severely depleted nursing workforce is going into winter running on empty, whilst trust leaders sound the alarm that they can't guarantee high quality care. This is a deeply worrying moment for patients and for plans to tackle waiting lists.'