Health leaders fear the long-running dispute between the government and unions is breaking the fundamental relationship between the NHS and its staff.  

And the true extent and mounting cost of disruption from repeated waves of strikes has yet to surface, trusts warn.

Detailed soundings from more than 100 trust chairs and chief executives by NHS Providers - which represents every NHS trust in England including hospitals, mental health, community and ambulance services - reveal deep concerns about the lasting legacy of these protracted disputes.

As industrial action intensifies this week when junior doctors stage the longest walkout in the history of the NHS followed by a two-day strike by consultants and two days of strikes by radiographers after that, leaders say staff feel undervalued and ongoing action is resulting in ever more entrenched positions.

Saffron Cordery, deputy chief executive of NHS Providers, said:

"The impact of these disputes is fraying the fabric of the NHS, held together by a unique sense of commitment and shared endeavour across the workforce that has served it so well over so many years. We lose that at our peril.

"The disruption for many thousands of patients and the potential harm of delaying their treatment is a huge and growing risk for the NHS to manage. Trusts will hardly have time to draw breath after a five-day walkout by junior doctors before consultants strike for two days, followed by a two-day strike by radiographers.

"The domino effect of repeated waves of industrial action is eroding the fundamental relationship between trust leaders and their staff.

"Trust leaders understand the strength of feeling among striking staff, who they value and work with for patients every day, and why they are taking action. Trusts will continue to do everything they can to limit disruption and keep patients safe but that's getting harder and more expensive with every strike as the cost of hiring cover grows, and with staff dissatisfaction increasing as disputes remain unresolved.

"Eight consecutive months of industrial action across the NHS are taking their toll not just on patients, with more than 651,000 routine procedures and appointments forced to be rescheduled, but on already overstretched services - hampering efforts to cut waiting lists.

"Even at the eleventh hour, looming strikes can be avoided. We urge the government and the unions to find a way forward and prevent thousands more patients paying the price of these disputes."