A poll of healthcare leaders found that 92 per cent are concerned about their ability to cope as the colder months arrive.

Niall Dickson, chief executive of the NHS Confederation which represents all health service organisations, said that there was “an even greater sense of foreboding” this year than last.

Writing in The Times today, Mr Dickson warns: “It is becoming hard to overstate the perilous state of the health and care system in England.”

His comments came as figures revealed that the number of the most critically ill patients waiting more than an hour for an ambulance has doubled in a year.

A separate report also suggested that 25,000 operations were cancelled last year because of a lack of beds.

Mr Dickson writes: “A cash injection at this stage is unlikely to solve the winter pressures, but the chancellor must revisit the pencilled in figures for 2018-19 and 2019-20, which if left as they are, would guarantee more crises and further delays to the reforms that are needed.”

He highlighted issues in A&Es last winter when there were ten hospitals in which less than 70 per cent of patients were seen within the four-hour target.

“Emergency departments are seen as a litmus test for the rest of the system. If the health service cannot cope at its front door, what lies behind it will also be struggling,” he says.

There has not been enough investment in community health and social care services, he adds, and draws attention to problems with staff recruitment and retention.

Figures released in July showed that the number of nurses and midwives fell by 1,783 to 690,773 in the financial year 2016-17 as 20 per cent more people left the profession than joined it.

Mr Dickson writes: “Emergency admissions are continuing to rise — in the first quarter of this year there was a 25.9 per cent jump in responses to life-threatening ambulance calls — so the ambulance service too is under increasing strain.”

Yesterday figures released to the Sunday Mirror under freedom of information laws showed that paramedics had taken more than an hour to reach 6,096 people requiring urgent treatment for conditions such as cardiac arrest in 2016-17. The total of “red” calls, which should be reached in eight minutes, waiting more than an hour was up from 2,746 in 2015-16.

Mr Dickson says that concerns have been heightened by fears of a flu epidemic. Simon Stevens, chief executive of NHS England, said last month that hospitals in Australia and New Zealand had struggled to cope with “a heavy flu season”, with the likelihood that the same strains of flu will head west and north.

Mr Stevens reiterated calls for “a comprehensive review looking at the funding of health and social care across the UK”.