A leading health economist said many feared care could suffer as a result of 'unprecedented' financial pressures on the NHS.

One third of 48 NHS finance directors questioned by the King's Fund said they believed the quality of patient care had worsened over the past year.

More than a third of 58 social service directors polled said they expect to be forced to cut services in the next 12 months, and nearly a fifth anticipated increasing charges to social care users.

The survey formed part of the King’s Fund's quarterly monitoring report. This also revealed that 24,313 full-time NHS posts were axed between March 2010 and October 2012.

More than 4,000 nurses, midwives and health visitors posts were axed and 8,000 manager positions. Yet, the number of consultants rose by 12% in the same period.

The report said although most NHS organisations are on track to meet financial targets, pressures are growing towards the end of the second year of the 'Nicholson Challenge' to find £20bn in efficiency savings by 2015.

Professor John Appleby, chief economist at the King’s Fund, said: ‘The NHS faces unprecedented financial pressures, and there are growing worries that patient care will suffer. For social care, it will be increasingly difficult for councils to make further savings without directly cutting services or affecting quality.

'Health and care services have coped well until now, but it is clear that many organisations expect things to become much more difficult over the coming year.’

On Tuesday, health minister Lord Howe said he believed the NHS will have 'one of its best years' ever in 2013 because of GP commissioning.

• Read the King's Fund report here