John Appleby, chief economist at The King’s Fund, also warned services in some hospitals could seriously deteriorate due to the impact of the economic crisis.

He said it was highly unlikely the NHS budget would be significantly increased in the foreseeable future.

Against this grim financial background managers are being asked to get 5p more value from every £1 they spend, every year, partially to keep up with the increasing demands of an ageing population.

Patients have already experienced the effect of this. For example, nine in 10 trusts have introduced tighter criteria to qualify for a range of procedures deemed to be of ‘low clinical value’ - including hip and knee replacements, cataract removals and weight-loss surgery.

Doctors and patient groups have argued that these are unfair and will be more expensive in the long run.