Hospital waiting times will grow and patients' access to treatments will be limited because of the squeeze on health spending, more than half of NHS chief executives and chairmen believe.
The warning from the heads of nearly 250 health providers comes as the NHS sets out to save £20bn from its budget over four years. Yesterday Andrew Lansley admitted that the NHS would have to find £4bn of savings next year because of the increased demands on the service.
"We are taking steps to cut the costs of administration and focus resources on the front line," he said.
But in the first survey of NHS organisations since the Government's efficiency drive was implemented, managers said reducing administration costs alone would not be enough and that tough decisions on cutting and merging services would have to be made.
One in five said they believed the quality of care their institutions offer will decrease over the next 12 months while almost a third thought care would get worse over the next three years.
Nearly 50 per cent said the financial situation facing their organisation was "the worst they had ever experienced", while an additional 47 per cent said it was "very serious".
The head of the organisation representing NHS employers warned that unless hospital managers were able to merge or cut under-utilised services the effects on patient care would be even greater. "We have to get politicians to understand and support the case for reconfiguring hospital services," said Mike Farrar, the new chief executive of the NHS Confederation.
"I can have a conversation with an MP in private where they say they back plans to reconfigure services – but in public they feel compelled to go to the front of the march protesting against them." At the Confederation's annual conference later this week Mr Farrar will call on the Government to stop attacking managers and referring to them as "bureaucrats".
"We face an unprecedented financial challenge ... unwarranted attacks on managers, unprecedented confusion over policy and unprecedented nervousness about how we can deliver what's asked of us," he will say. "We need recognition of the enormous job we face and action to help, rather than hinder us in delivering it."
Managers also warned that cuts to local authority budgets would have a significant knock-on effect on demand for NHS services – as people were increasingly sent to hospital rather than being cared for in the community.
Eighty-six per cent said there would be a delay in patients being discharged from hospital while 63 per cent said they believed cuts would result in more emergency and acute admissions.Reuse content