NHS Providers has warned that the health service has, over the last month, become as stretched as it was at the height of the pandemic in January, and the situation is likely to get worse before it gets better.

In a letter to Prime Minister Boris Johnson, Chancellor Rishi Sunak, Health Secretary Sajid Javid, and chief executive of NHS England, Sir Simon Stevens, the organisation sets out a combination of pressures which many trust leaders say now, collectively, match the strain the NHS was under at the start of the year.

These include: work to recover care backlogs across hospital, mental health and community services; record levels of demand for urgent and emergency care; growing admissions for Covid-19 alongside increasing mental health and long Covid pressures; continuing additional infection control measures restricting capacity; a large number of staff self-isolating and increasing numbers suffering from stress and mental health issues; and high levels of summer leave, including time-off that was postponed earlier in the pandemic.

The letter warns these pressures will probably intensify in the coming months as the service contends with continuing coronavirus infections; the challenges of extending the vaccination programme, organising boosters and the expanded flu campaign; and dealing with what is expected to be one of the most difficult winters the NHS has ever faced.

NHS Providers calls on the government to make 'the right decisions' over the next month as it finalises NHS funding for the second half of the financial year. Such decision should include the continuation of discharge funding, top up financial support for planned operations, and emergency capital funding to expand emergency departments, crisis mental health services and community and ambulance capacity in time for winter.

Chris Hopson, NHS Providers chief executive, said: "The NHS has delivered in an extraordinary way over the last 18 months, often at the drop of a hat. Many NHS chief executives believe the next phase of our fight against Covid-19 is likely to be the hardest yet given the scale and breadth of pressures they face. They are clear that, now more than ever, the NHS must get the funding it needs to win that fight.

"Trust leaders have strongly welcomed the financial support they've received over the last 18 months. It's been crucial to coping with Covid-19. But the government is currently stressing the need to repair the public finances and some are arguing that NHS funding can 'return to normal'.

"Trust leaders want the government to be clear with the public about the scale of the challenges the NHS faces over the next nine months. A massive care backlog to get through, a much more complex second phase vaccination campaign, likely further waves of Covid-19 and the prospect of one of the worst winters on record.

"Trusts and frontline staff are committed to maintaining the quality of care that patients rightly expect through these challenges. But that can only happen if the government provides the right funding for the rest of the year. Trust leaders are seriously worried that the current signals from government indicate this won't happen."