Pressures in the NHS are so great that even the best hospitals in England are seeing patients wait longer for key services, an analysis shows.
The Nuffield Trust report looked at performance in this Parliament against six targets, covering A&E, operations, cancer and diagnostic tests.
It found most patients were still being seen within the target times at the 156 hospital trusts.
But it said even the top sites were seeing their performance decline.
The six targets analysed were the:
- four-hour A&E wait to be treated, discharged or admitted, following arrival
- 18-week wait for routine operations, such as knee and hip replacements
- 18-week wait for appointments, such as a clinic with a consultant
- six-week wait for a diagnostic test, following GP referral
- two-week wait to be seen, following an urgent cancer referral
- 31-day wait for cancer treatment, after a diagnosis
The review said the poorest performing hospitals had been getting worse on most measures for a while.
But it said more recently performance had also started to decline in the top 10% of hospitals, particularly in terms of A&E, hospital operations and, to a lesser extent, hospital appointments.
It said this suggested the problems were "systematic" rather than caused by local or managerial failings.
NHS performance in numbers- Only 92.6% of A&E patients were seen within four hours in the last quarter of 2014 - the worst level for a decade
- The target to see 90% of patients needing an operation within 18 weeks has not been met since the first quarter of 2014
- There are 2.9 million people currently waiting for routine hospital treatment
- The target to give diagnostic tests to 99% of patients within six weeks of referral has not been met since the last quarter of 2013
- The number of hospital diagnostic tests being carried out has risen from 6.6 million in 2010-11 to 8.8 million in 2013-14
- The target to ensure 96% of patients with cancer start treatment within 31 days of a diagnosis has been met throughout this Parliament
- The number of people being urgently referred for cancer has risen by 13% in the past year, but the two-week target to be seen also continues to be met
The report acknowledged demand for services had increased significantly - the number of hospital diagnostic tests and urgent cancer referrals have both risen by more than 10% .
But it said this did not necessarily seem to be directly linked to similar drops in performance.
For example, the number of hospital operations being done has actually dropped slightly - but the waiting-time target is among those where performance has declined most steeply.
Warning lightsReport co-author Holly Dorning said: "We've known that hospitals have been struggling to meet the four-hour A&E target for a while.
"But the fact that we are starting to see problems in other areas, like access to planned treatment, is a real concern.
"As this study makes clear, warning lights are now starting to flash across the wider hospital system."
A spokesman for the Department of Health said: "The NHS is busier than ever, as innovative treatments and medicines mean people are living longer with complex conditions like heart disease or diabetes.
"We've increased the NHS budget this Parliament, but ultimately we want to reduce pressure on services through our plans to increase access to primary care and look after people better in the community."
Shadow health secretary Andy Burnham said: "The NHS has been thrown off course by [Prime Minister] David Cameron's reorganisation, and it is now failing to deliver - leaving thousands of people without the standards of care they deserve."
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