The NHS is set to face an “even tougher winter” than the record-breaking crisis it weathered less than 10 months ago, as hospital bosses warn of staff and funding shortages.

Despite the government claiming the health service was “better prepared than ever” last year, ambulance queues tripled, there were fewer beds available and doctors wrote to Theresa May warning of patients “dying prematurely” in corridors.

Hospital leaders said the major issues of workforce, funding and social care remain unresolved, and figures released on Thursday show how an unprecedented summer heatwave has left no time to tackle the significant backlog in operations.

Theresa May has pledged an extra £20bn for the NHS by 2023 but this will not start to plug gaps until April 2019.

Meanwhile, hospital heads told The Independent funds usually held in reserve to add capacity in winter were already used up, or useless because there was no one to work.

“All the money for winter has been spent managing this summer,” one trust director from the northwest of England, who did not wish to be identified, told The Independent.

“The demand is basically constant all year round now, if you look at the figures, so there are no ‘extra’ beds because they’ve all been kept open.”

Another director, from a hospital in Greater Manchester, said that although they had around 70 beds on wards they could use to boost capacity, they would have no one to safely staff them because of more than 100 vacant nursing roles.

“The reality on the ground is that we are seeing huge workforce gaps,” Saffron Cordery, deputy chief executive of NHS Providers, which represents health service trusts, told The Independent.

“The gap has gotten bigger [in the past year] but whether it’s growing or shrinking is immaterial because the gaps are there and demand is only going one way”

NHS in Crisis march: in pictures Show all 25 1 /25 NHS in Crisis march: in pictures NHS in Crisis march: in pictures Protesters call on the government to reverse cuts to the NHS. Rex NHS in Crisis march: in pictures Demonstrators dressed as an undertaker and carrying a fake coffin. Getty Images NHS in Crisis march: in pictures Demonstrators gather on Gover Street in central London ahead of a march towards Downing Street to protest against underfunding and privatisation of the NHS and demand an end to the winter crisis in the health service. Rex NHS in Crisis march: in pictures Health workers and NHS campaigners march through London to a rally outside Downing Street. Rex NHS in Crisis march: in pictures Thousands of protesters marched during the demonstration organised by 'The People's Assembly Against Austerity' campaign group that called for better funding for the National Health Service (NHS) to end the 'winter crisis' in the national health care system. EPA NHS in Crisis march: in pictures A Boris Johnson impersonator lies in a makeshift hospital bed next to an effigy of Theresa May during a People's Assembly demonstration against the Conservative government's health policy. Getty NHS in Crisis march: in pictures A demonstrator in a mobility scooter carries a placard. Getty NHS in Crisis march: in pictures Demonstrators take part in a emergency NHS 'Fix It Now' protest demanding an end to the funding crisis in the Health Service. Rex NHS in Crisis march: in pictures Demonstrators take part in pro-NHS march and protest towards Downing Street in Central London. EPA NHS in Crisis march: in pictures A protestor carries a placard featuring Britain's Health and Social Care Secretary Jeremy Hunt. AFP/Getty NHS in Crisis march: in pictures The demonstration is focused on the current crisis in the National Health Service. Getty NHS in Crisis march: in pictures Demonstrators hold placards and set off flares . Getty NHS in Crisis march: in pictures A demonstrator carries a cardboard skeleton wearing an ambulance uniform . Getty NHS in Crisis march: in pictures Demonstrators hold placards during a People's Assembly demonstration against the Conservative government's health policy Getty NHS in Crisis march: in pictures The Government will be urged to provide more beds, staff and funds to ease the problems facing the service. PA NHS in Crisis march: in pictures Protestors gather calling for an end to the "crisis" in the NHS. AFP/Getty NHS in Crisis march: in pictures Shadow Health Secretary Jon Ashworth M joins people taking part in the march. PA NHS in Crisis march: in pictures A placard reading 'Nurses with fight for the NHS'. AFP/Getty NHS in Crisis march: in pictures Protestors carry placards and shout slogans. AFP/Getty NHS in Crisis march: in pictures People march through central London. PA NHS in Crisis march: in pictures People take part in a march in London in support of the National Health Service. PA NHS in Crisis march: in pictures People hold up a sign in support of the National Health Service to demand an end to the "crisis" in the NHS. PA NHS in Crisis march: in pictures Protestors carry placards featuring Britain's Prime Minister Theresa May and Britain's Health and Social Care Secretary Jeremy Hunt. AFP/Getty NHS in Crisis march: in pictures People take part in a march in London in support of the National Health Service. PA NHS in Crisis march: in pictures Demonstrators carry placards . Getty

“We don’t know what will happen with flu, or the weather – obviously – but we do know we had adverse weather over the summer and in some places it exceeded winter demand in A&E.

“There was not even enough time to get over winter before one of the hottest summers since 1976, so now we’re just getting over the summer and going straight in to winter.

“That’s massive and it affects money, planning, capacity, workforce.”

NHS statistics, released on Thursday for the quarter July to September, show that more patients this summer waited over four hours to be seen at A&E and to be admitted to hospital as emergencies than a year ago.

Demand in emergency care is similarly unchecked and the proportion of patients waiting more than six weeks for diagnostic tests are at the highest level since records began.

The Royal College of Nursing said missed cancer targets – now unmet for five years – “represent untold suffering” for patients who know delays can be the difference between life and death.

“These figures sound the alarm bells for the NHS as we head towards winter,” the college said.

'NHS is better prepared than ever before' says Theresa May on Winter Crisis

The NHS is seeing more patients than ever before, and in September attendances at A&E rose above 2 million, a 7 per cent increase on the previous year.

Last winter hospitals and social care made progress on cutting “delayed transfers of care”, where patients are well enough to go home but get stuck in hospital beds because of a lack of nursing staff to care for people at home or in residential care.

This year trusts have been asked to reduce them by another 25 per cent – freeing up potentially thousands of beds across England.

Health service chief executive Simon Stevens said on Tuesday: “Above all we have got to build on the progress we have made on freeing up inpatient beds through enhanced work with community services and social care.”

This is in addition to an improved flu jab, which it is hoped will cut seasonal illness. Trusts will be monitored to ensure staff are vaccinated as well.

A Department of Health and Social Care spokesperson said: “We’re supporting the NHS with an extra £420m this winter to redevelop A&Es, improve emergency care and help get patients home quicker, while the long-term plan to guarantee the future of the health service will be backed by an extra £20.5bn a year by 2023/24.”

But delayed transfers in August were higher than in December 2017 and a report today from the Care Quality Commission warned social care providers in parts of the country have hit a “tipping point”.

In many parts of England a lack of adequate social care means more patients will fall ill and head to hospital as emergencies.

“Despite great effort from staff across the country, the grim reality is that so far these figures trace the course to an even tougher winter for the NHS,” economist John Appleby, director of research at the Nuffield Trust think tank, said of the latest performance figures.

“The root cause is a discrepancy between the money and staff available, and the needs of patients. Emergency admissions are up an astonishing 7 per cent since this time last year. The significant sums of much-needed new money pledged by the prime minister will arrive next April. The difficult questions for the NHS are how it can use that to make a difference – and how it can cope until then.”