The NHS timebomb: Our health system is at breaking point and its founding principles at stake, warn leading doctors, nurses and charities

In a letter published exclusively in The Independent, they stress the need for a “fully costed spending plan” if the £30bn “black hole” in the health service’s finances is to be addressed.

They paint a stark picture of the NHS and care system failing to meet crucial cancer targets and unable to help thousands of elderly and vulnerable people, often suffering from dementia, whom they say “have been cut adrift”. Too many staff “feel undervalued and demoralised,” they add.

The letter comes as leading experts warn that pledges on health and care spending made by Labour and the Conservatives will not be enough for the NHS or cash-strapped social care services to even maintain current levels of service, let alone improve under the next government.

Leaders of unions, charities and medical royal colleges, including the British Medical Association and the Royal College of Nursing, express concern that the health and care system is “buckling under the twin crises of rising demand and flat-lining budgets”. The signatories represent hundreds of thousands of health professionals, patients and carers.

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Signs of strain are already evident in rising waiting times for A&E, cancer treatment and GP appointments, they say, while demands on midwives are denying new mothers the care they deserve, and mental health services are under severe pressure.

They also highlight the crisis of families “crippled” by the cost of social care and call for any spending plan for the NHS to include social care, which is the responsibility of councils.

“The anxieties of people working at the front line of the health and care services are well-known,” they write.

While welcoming David Cameron and Ed Miliband’s focus on the NHS during their party conferences, they say “a comprehensive, fully-costed, long-term spending plan” is needed to secure an “NHS true to its founding principles of universal healthcare, provided according to need not ability to pay” for future generations.

Other signatories to the letter include the Royal College of Midwives, five of the medical royal colleges and charities including the Alzheimer’s Society.

In the past four years, the NHS has endured the longest period of funding restraint in its 66-year history. Although the £113bn NHS budget has been protected, rising patient demand driven by a growing, ageing population, and an increasing number of patients living with long-term illnesses, has continued.

To meet demand, and also improve quality of care in the wake of the Mid Staffordshire scandal, NHS hospitals have recruited thousands of extra staff in the past two years. But two-thirds of hospitals are now in the red financially, while key waiting times targets are being missed across the board.

NHS England predicts that if demand continues to increase and spending increases remain as low as they have been, the health service could, by 2020, be £30bn short of what it needs to provide the same level of service it does today.

“By the end of this year the NHS could well be overspent in net terms,” said John Appleby, chief economist at the King’s Fund think-tank. “We don’t know how much, but maybe not far off £1bn. Someone has to pick that tab up. It doesn’t disappear. The Treasury are going to have to find money for that, whoever is in power.”

It is estimated the NHS would need real-terms increases of around 4 per cent each year of the next Parliament to fill the funding gap, around £4-5bn more a year.

Last week, David Cameron pledged to “protect the NHS budget and continue to invest more”. “If the pledge is to ‘protect’ the NHS as it has been ‘protected’ in the last five years then the NHS is in trouble,” said Mr Appleby.

Chris Hopson, chief executive of the Foundation Trust Network, which represents NHS hospitals, said the country was “under-funding the NHS for the amount of care we are asking it to provide”.

Labour, meanwhile, has pledged £2.5bn extra for the NHS each year. But Mr Hopson said neither of the main political parties “goes any kind of distance” towards filling the long-term funding gap.