NHS finances have been ‘stretched to the limit’, influential think tank The King’s Fund has warned.

The King’s Fund said that there are “huge pressures” on the health service’s purse strings after a quarter of finance directors at hospital trusts in England said they expect to overspend their budgets this year.

Its latest report on NHS financial woes found “a distinct lack of optimism about the general state of the finances” with 85 per cent of the 73 finance directors polled saying they were fairly or very pessimistic about money for the next year.

The King’s Fund said that “cracks are beginning to appear” in performance as a result of the growing financial pressures.

A number of waiting time targets have been missed and the number of people on waiting lists for treatment in hospital is now at its highest level for six years, the report stated.

While many organisations are worried about their finances, they have still taken to employing more nurses.

Between August last year and March this year, the number of nurses, midwives and health visitors employed by NHS England grew by nearly 9,000, boosting the nursing workforce to its highest level ever, the authors said.

A spokeswoman for the King’s Fund said that these findings underlined “the difficult choice facing hospitals - whether to balance the books or maintain quality of services - with many choosing to recruit more nurses despite their budgets being stretched to the limit”.

A further 47 finance chief executives from local health authorities and clinical commissioning groups were surveyed.

But the report authors said that there was a “significant disparity” between the views expressed by those who commissioned services - CCG finance workers - and those who delivered them - NHS hospital trust finance leads.

Half of providers said they expected an increase in activity in their emergency rooms while 55 per cent of commissioners are planning for a reduction in emergency work.

Meanwhile, 70 per cent of hospital trust finance leaders said they expected a rise in elective surgery compared to 32 per cent of those speaking on behalf of the commissioners.

John Appleby, chief economist at the think tank, added: “Our latest quarterly report paints a picture of a service under huge pressure, with cracks beginning to appear in NHS performance.

“It once again underlines the need for new funding if services are to be maintained.

“The increase in the nursing workforce signals a very welcome commitment to improving care, although it remains to be seen whether hospitals will be able to sustain current staffing levels when money becomes tighter later in the year.

“The disparity in the plans of providers and commissioners points to a worrying mismatch between activity and funding, which could have serious financial consequences.”

A Department of Health spokeswoman said: “Pessimistic predictions of this type are nothing new, but we know that the NHS remains stable.

“Some parts of the system are under pressure due to an unprecedented rise in demand, which is why we have taken tough decisions to increase the NHS budget by £12.7bn over this parliament and are ensuring the NHS is sustainable in the long term.”