Responding to the National Audit Office (NAO) report “Sustainability and transformation in the NHS”, the chief executive of NHS Providers, Chris Hopson, said:

"This report is an emphatic endorsement of many of the concerns we have raised in recent months.

"It shows that NHS trusts managed to improve their overall financial position last year while treating more patients. But for the first time ever the health service missed all the main performance targets for treatment in A & E, routine operations, cancer care and ambulance response times.

"Extra funding to facilitate better, more convenient and sustainable ways of providing care for patients was used up just keeping the show on the road. And some of the short term measures to raise revenue, such as the raids on capital budgets, meant planning for the future was further compromised.

"And we have warned repeatedly that the growing reliance on one-off measures is not a viable long term approach.

"The NAO is right to highlight the increase in direct cash injections in order for trusts to deliver day-to-day services. This is symptomatic of the cost of care outstripping available funding.

“The report is also right to highlight the decidedly mixed picture of progress we are seeing with the development of Sustainability and Transformation Partnerships (STPs) and accountable care. They present an important opportunity – which we must not miss - to re-shape services to meet the changing needs of people in their communities.

"We agree that focusing investment on the most “advanced” areas means others may be left still further behind.

"And the NAO is right to warn that many STP plans are over-optimistic, and that failure to address this will lead to very difficult choices ahead.

"Taken as a whole, it is clear that the NHS has now reached a watershed moment. We need long term decisions to be taken on the funding of health and social care no later than the autumn budget, and we urge the government to respond with urgency.”