NHS leaders in England say they have reached a “tipping point” and cannot maintain standards for patients on the funding they are getting.
Chris Hopson, chief executive of NHS Providers, said many hospital bosses wanted to “sound a warning bell” to political leaders.
It comes after latest figures showed record levels of delayed hospital discharges and patient waiting times.
The government has said it is giving NHS England the 10bn it asked for.
NHS Providers, the organisation that represents hospitals in England, says unless urgent funding is provided it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment.
It highlights that 80% of England’s acute hospitals are in financial deficit, compared with 5% three years ago – while missed A&E waiting time targets have risen from 10% to 90%.
Writing in The Observer Mr Hopson said: “Thanks to the dedication of staff, NHS performance rarely goes off the edge of a cliff. As the 1990s showed, instead we get a long, slow decline that is only fully visible in retrospect.
“It’s therefore difficult to isolate a single point in that downward trajectory to sound a warning bell. But NHS trust bosses are now ringing that bell.
“We face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate… Something has to give.”
He added that trusts would “do all they can to deliver efficiency savings and productivity improvements” but “the NHS must make some quick, clear choices on what gives, however unpalatable these choices may be”.
Mr Hopson blamed cuts in social care and mental health services for causing “major problems” such as record numbers of healthy people not being discharged because of a lack of community care.
His warning comes days before the Commons health select committee will decide whether to launch a special inquiry into the state of the NHS in England and two months before the government announces its spending plans in the Autumn Statement.
In July more than 50 hospitals in England were given the go-ahead to miss key waiting time targets this year to help ease their financial problems.
Fines for missing targets in A&E, cancer and routine operations have also been scrapped altogether and a new failure regime is being set up for the worst-performing trusts.
The Vale of York trust considered suspending non-urgent treatment for obese patients and smokers for a year in order to ease financial pressures before bosses intervened.
The Department of Health has previously said it is giving the NHS in England the 10bn it asked for in order to fund its own plan for the future. It added that it expects the service to continue to ensure patients get treated quickly.
Read more: http://www.bbc.co.uk/news/health-37331350