By 2020 an additional £30 billion will be needed to keep the NHS running at the current level of service provision / Getty Images

NHS is 'creaking at the seams' amid increased demands because of the ageing population – partly a result of improved health care.

The NHS will have to start charging patients unless taxes are increased or major cuts are made to the service, leading health figures have warned.

Officials from the Royal College of Nursing, Royal College of General Practitioners and Royal College of Physicians among others said in a letter that the NHS was “creaking at the seams” amid increased demands because of the ageing population – partly a result of improved health care.

“We can all celebrate the success of rising life expectation. Yet because most of us are living longer, the next 50 years will see a growth of at least two and a half times as many people suffering from multiple problems,” the letter, which was sent to The Times, said.

“Unless action is taken, by 2020 maintaining the current level of service provision will require an additional £30 billion for just the NHS — which is as much as we spend each year on defence.

“There is an equivalent budget crisis in social care and housing. The status quo is not an option. We are already seeing the signs of the system creaking at the seams.

“All financial options are difficult politically; higher tax spend, co-payments or changes to what is available.”

The letter added that more should be done to “eliminate inefficiencies” and “wasteful variation in care”.

“Resources and vigorous service reform must go hand-in-hand. Business as usual won’t do,” it said. “However, the longer-term response to this unprecedented financial challenge needs an honest, open dialogue between politicians and citizens. We need a new settlement; a fundamental, holistic agreement with the country on what health and social care should be, how and where it is delivered to maximise the quality of care, and how it should be paid for.”

The letter called for an all-party, independently conducted “national conversation” on health and social care. “It needs to start now and be completed by the end of next year. We call on political leaders to support and assist this proposal,” it said.

According to a ComRes poll, 63 per cent of people think the NHS does not have enough money, while just 5 per cent of voters think the NHS has improved and 37 per cent believe it has got worse.