The NHS is a "super-tanker heading for an iceberg" without reforms, warns NHS Confederation Chief Executive Mike Farrar.
Ahead of the organisatonfs three-day conference in Manchester due to kick off today (20 June), Farrar said healthcare leaders are "deeply concerned" about the storm clouds gathering over the NHS.
A survey of NHS managers found 28% described the financial situation as "the worst they had ever experienced", 46% said the economic position of the NHS was "very serious" and only 5% thought it was "better".
More than one in four managers (42%) polled said patient care had been the most affected by financial pressures, followed by waiting times (35%), and the availability of treatment and drugs (17%).
Almost half (47%) also believe patient care nationally will decline over the next 12 months.
"Our survey shows that many NHS leaders see finances getting worse and that this is already having a growing impact on their patient," said Farrar.
"In response, they are cutting costs in the short-term but they know that much more radical solutions are the only answer in the long run.
"Frankly, without action on the way we provide health and social care, the NHS looks like a super-tanker heading for an iceberg. The danger is clearly in view and looming ever larger. We know what needs to happen. But are we going to be able to take the assertive action needed in time?"
Farrar criticised politicians for consistently failing to put the long-term interests of population health above their "short-term electoral interests".