The NHS is as stretched now as it was at the height of the pandemic in January and things will get worse before they get better, health leaders have said.

In a letter to Prime Minister Boris Johnson, Chancellor Rishi Sunak, Health Secretary Sajid Javid, Chief Secretary to the Treasury Steve Barclay, and NHS England chief executive Sir Simon Stevens, NHS Providers said a combination of pressures are being experienced by the health service.

“This combination means that many trust chief executives are saying that the overall level of pressure they are now experiencing is, although very different in shape, similar to the pressure they saw in January of this year when the NHS was under the greatest pressure in a generation,” the letter said.

It called 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.

Pressures on the NHS include going “full speed” to address the backlog of care across hospital, mental health and community services; and record levels of demand for urgent and emergency care.

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

The letter also pointed to growing hospital admissions for Covid-19 alongside more cases of long Covid and people suffering poor mental health.

It said hospitals are currently running enhanced infection control measures, leading to “significant loss of capacity”, while more staff are off either self-isolating or suffering stress and mental health issues.

NHS Providers also pointed out that staff are “quite rightly” taking summer annual leave, including time-off that was postponed earlier in the pandemic.

The letter warned these pressures will probably intensify in the coming months due to Covid-19, expanded vaccination programmes and dealing with what is expected to be one of the most difficult winters the NHS has ever faced.

NHS Providers chief executive Chris Hopson 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, 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.”

Among the demands are a call for discharge funding to be continued to free up beds, more financial support for planned operations to make progress on the backlog, and emergency capital funding to expand emergency departments, crisis mental health services and community and ambulance capacity in time for winter.

NHS leaders also said the 3% pay rise for staff must be funded by the Government to ensure trusts “do not have to eat into other budgets, risking patient care”.

More and continued use of the private sector should also be established to help clear the backlog, while there should be no repeat of what happened previously when the NHS budget for six months was “confirmed just 13 days before the start of the new financial year”, they said.