Rising demand for NHS services combined with severe workforce pressures and an underfunded social care system means there is a still a long road ahead for trusts in tackling care backlogs.

A report by NHS Providers which represents every NHS hospital, mental health, community and ambulance service in England, says trusts and their frontline staff are working flat out caring for more patients with activity levels for mental health, cancer services and diagnostics exceeding pre-pandemic levels.

NHS reality check: the financial and performance ask for trusts highlights trust leaders' concerns that, despite this progress, many people are still waiting longer than they should to access physical and mental health services with some targets taking longer to deliver than expected.

The report includes findings from a survey of trust leaders covering hospital, mental health, community and ambulance trusts, with 106 responses accounting for 50% of the provider sector. These show:

• 92% said persistent workforce shortages were the most significant barrier to increasing activity
  
  
• 86% said difficulties in discharging medically fit patients in a safe and timely manner was a key barrier
  
  
• 67% were confident or very confident that they would eliminate year-long waits for routine operations by March 2025, but only 37% thought they would be able to deliver the required increased activity levels this year
  
  
• 79% said increasing demand for services was preventing their system from making activity gains in 2022/23
  
  
• 51% were not confident that their system would be able to deliver its targets to reduce long waits across mental health services
  
  
• 95% said the financial ask for the coming year would be difficult or extremely difficult.

The report also highlights how the pandemic has deepened existing pressures, leaving trusts facing a tough task in 2022/23 to meet patient need within the current funding settlement while delivering stretching efficiency targets. Trust leaders are grappling with tightened finances alongside several operational pressures and efforts to address care backlogs.

A recent cash injection of an extra £1.5bn by NHS England and NHS Improvement has been welcomed by trust leaders as a recognition of the inflation challenge. But questions remain over whether this funding – which has been redirected from elsewhere across NHS England and NHS Improvement's budget – will significantly improve the financial health of the provider sector, given the range of cost pressures trusts face.

And with trust leaders strongly supportive of an appropriate pay uplift for NHS staff this year, they need reassurance that any rise will be fully funded by government.

The interim chief executive of NHS Providers, Saffron Cordery, said:

"No one should doubt the determination of trust leaders to increase activity and bear down on waiting lists. They understand only too well the disruption and distress for patients and their carers caused by delays for treatment.

"They also know the crucial importance of spending every pound of public money wisely, and innovating to improve care and deliver efficiency savings.

"This report shows there is absolutely no complacency about the scale of the challenges trusts face this year. But it also serves as a reality check, as they work to meet these ambitions.

"We went into the pandemic off the back of the longest financial squeeze in the history of the NHS, with capacity falling behind growing demand – a problem aggravated by severe staff shortages and an underfunded social care system.

"The pandemic exposed and deepened those fault lines, and shone a harsh light on worrying health and race inequalities.

"It is a great credit to trusts, their partners across health and care, and above all to frontline staff that we are seeing real progress in increasing activity and tackling some of the longest waits for treatment. Trust leaders are determined to build on this, but given the challenges they face, there is a real chance that some targets will take longer to meet than they would like.

"It is time to be honest about what they are up against. Obstacles include continuing severe pressures on urgent and emergency care, the persistent threat of COVID-19, workforce shortages, discharge delays and overstretched social care services.

"Understandably, everyone wants to move on from the pandemic and see normality restored. Trusts are doing all they can to do that and more, transforming the health and care system to tackle current pressures and meet future needs. It's a huge challenge. They have embraced that challenge. But people should know, it will take time."