Around a quarter of finance leaders are concerned that quality of care for patients in the NHS will deteriorate over the next year, a new survey suggests.
More than a quarter (28%) of chief finance officers for local health bodies, clinical commissioning groups (CCGs), think quality will deteriorate in 2017/18 and 29% think it will get worse in 2018/19.
And 24% of trust finance directors think quality of patient care will deteriorate in 2017/18, rising to 32% for 2018/19, according to the poll of finance directors and chief finance officers from 100 provider trusts and 73 CCGs from across the NHS in England.
When asked which service qualities were vulnerable because of the current financial challenges, the most common area identified was waiting times, with 86% of finance directors identifying it as vulnerable.
Some 42% of finance directors said the financial pressures have caused A&E waiting times to increase and 50% think they have caused elective waiting times to increase over the last year.
The authors of the Healthcare Financial Management Association's (HFMA) NHS Temperature Check report concluded the financial performance of the NHS in England remains under significant financial pressure.
They added the results of the survey depict a difficult financial year ahead for trusts and CCGs alike, with finance directors commenting that 2017/18 will be the most difficult year yet.
Most trusts in the acute sector are forecasting a deficit for 2017/18, while most mental health and community providers are predicting a surplus.
However, most trusts (84%) and CCGs (63%) performed as well or better in 2016/17 than they expected at the beginning of the financial year.
Mark Orchard, president of HFMA, said: "The last few years have been the most financially challenging that most of us in the NHS can remember and the challenges look set to continue.
"However, there are reasons to be positive. The level of efficiency savings delivered in 2016/17 by finance staff working in collaboration with their clinical and management colleagues should be applauded.
"In many ways, though, this is just the beginning. The efficiency challenge in 2017/18 is even tougher. Collectively, everyone in the NHS needs to find ways to be more resourceful, more innovative and more collaborative to address the financial challenge in front of us."