Ministers must be honest with the public that patients face “several years” of waiting longer than usual for treatment because Covid-19 has disrupted so many services, NHS leaders have warned. The health service is facing a “triple whammy” of pandemic pressures involving the recent rise in numbers of people being treated in hospital, a large backlog of patients not treated in the spring and the ongoing drive to restore normal care. NHS England has told hospital trusts to provide close to full levels of services for people with non-Covid illnesses by October, such as cancer patients and those needing surgery. But the NHS Confederation, which represents health trusts in England, makes clear in a report published on Tuesday that this target is not realistic. “In recent months the NHS has made huge progress in restoring services towards previous levels. However, the pandemic’s impact on the capacity of the NHS is likely to go on for several years,” it says. In a survey of 252 chief executives, board chairs and senior doctors working across all types of NHS care, 74% said they were not confident they could meet that target. In addition, just half of them said they felt they could resume the provision of cancer care by that deadline. As a result, “political leaders will need to help manage public expectations about what is possible”, especially as hospitals are grappling with the backlog from the spring, the confederation adds. The suspension of many NHS diagnostic and treatment services during the national lockdown has led to record numbers of patients waiting more than a year for care, especially surgery, that they should have had within 18 weeks. While some trusts have reopened many services, and are using extra sessions of care in the evenings and at weekends to help them tackle their waiting lists, others are behind schedule. Hospital bosses say the need to ensure physical distancing in hospitals, and for staff to wear personal protective equipment during surgery, as well as staff shortages, mean they cannot perform as many operations as before Covid. NHS chiefs also say the extra costs they will continue to incur as a result of the pandemic, such as an estimated 20% rise in demand for mental healthcare, means the service needs more money than the extra £20.5bn by 2023/24 that was announced in 2018 by the then prime minister, Theresa May. Danny Mortimer, the confederation’s interim chief executive, said Boris Johnson’s government was facing “a moment of truth” over its stewardship of the NHS. “Either it embraces what we have learned in recent months and provides the support and investment the NHS and social care need to get back on track and reform for the long term. Or they continue with short-term fixes, bailouts and ever-increasing targets and regulation that continue to stifle NHS staff from locking in the changes that are essential if the health service is to manage the threat of the pandemic and emerge in a stronger position,” he said. The Department of Health and Social Care said it was committed to helping the NHS tackle the pandemic and get services running again. A spokesperson said: “In July, the chancellor announced an extra £31.9bn for health services, plus an additional £16.4bn last week to tackle coronavirus and will continue to provide the NHS with the funding it needs. This is on top of a record cash funding boost of £33.9bn extra a year for the NHS by 2023/24.”