Responding to the latest performance figures for the NHS in England, Matthew Taylor, chief executive of the NHS Confederation, said:
"These figures once again demonstrate just how extremely hot the health service is running, and the intense pressure it continues to face as it heads into a very challenging winter.
"Despite this, health leaders are determined to make significant headway in clearing the backlog with 1.1 million procedures carried out in August.
"The numbers also show the significant demand across primary care, where teams have continued to see huge numbers of patients. 25.5 million appointments were carried out in August, including 14 million face to face consultations.
"However, we can’t hide from the fact that the NHS is facing rocketing demand for hospital care, mental health services, ongoing Covid pressures, with a workforce that is on the brink of burnout, and planning for an incredibly tough winter.
"Rather than stumbling into crisis the Government needs to recognise the inevitability of severe winter pressures and to explore how we can mobilise a national effort to support the health and care system through the coming months.
"The Government needs also to apply the evidence of these figures and the first hand insight of NHS leaders to imminent decisions in the spending review. With new figures showing that the maintenance backlog stands at £9.2bn, our members report a desperate need for investment to modernise their buildings and replace outdated equipment.
"The NHS will continue to do everything it can for its patients, but stretching the service so thinly is a dangerous game."