Research published today suggests growing pessimism in the NHS and social care as local leaders respond to mounting financial pressures.
A third of NHS finance directors report that the quality of patient care has worsened during the last year and more than a third of social services directors expect to have to cut social care services over the next year.
The findings are part of the King's Fund's quarterly monitoring report, a survey of NHS finance directors and directors of adult social services.
Mike Farrar, NHS Confederation chief executive, said: "The findings of this survey reinforce what our members have been telling us for some time. Despite huge efforts to maintain standards of care and finances, NHS leaders are increasingly concerned about the pressures mounting on their organisations and the knock on impact of reductions in funding for local government services.
Focus on patients
"The findings of the Francis inquiry reinforce the fact that we must keep the focus on patients first and foremost. We need to look beyond short term solutions that balance the books and examine how we can transform the way we deliver care so that it provides the best outcomes for people, in a way that is fully sustainable in the long term.
"Unless we start doing this now, we will continue to battle with growing financial pressures, putting strain on our ability to maintain standards of care."
He added: "The problems we face cannot be resolved by looking at one organisation in isolation. For sustainable, effective change, we must take the bull by the horns and produce whole-system solutions across the wider care system."
Find out more
Download the report from the King's Fund website.
Find out more about the Francis inquiry and the NHS Confederation's work to support members.
Find out more about the financial challenges facing the NHS and the Confederation's work to support members.