91Èȱ¬

Another week brings another batch of anecdotal evidence of the mounting pressures across the health service.

A 91Èȱ¬ investigation, through Freedom of Information requests, revealed tens of thousands of operations put off at short notice last year in England had not been recorded in official cancellation figures.

And because these had happened in the three days before the scheduled day, there was no guarantee they would be rescheduled within 28 days as there is with cancellations on the day of surgery.

Hospital chiefs acknowledge this is an area of concern and admit there is distress to patients if there is a postponement of planned surgery so close to the scheduled day.

But they blame the relentless rise in patient numbers, with emergency admissions having to take precedence over non-urgent surgery.

The dilemma is whether to leave more beds and operating-theatre time free for emergency cases or fill them close to capacity to get the required elective work done but risking inflicting last-minute cancellations on patients.

Bed occupation by patients fit enough to leave but who cannot get social care is another part of the problem.

A study by the Royal College of Physicians spoke of an overstretched workforce and some doctors so busy they .

As well as a recruitment crisis making some hospitals unsafe, according to the college, the NHS was seriously underfunded, and its leadership called for a new plan to meet the country's health and social care needs.

Doctors at 100 GP practices in Lincolnshire have drafted letters to commissioners , such as ear syringing and 24-hour blood-pressure monitoring, unless given extra cash.

This, according to the medical publication Pulse, would be the first organised action of its kind with the aim of highlighting the workload strains they face.

NHS England said it recognised the pressures on general practice and would support local attempts to deliver a range of primary-care services.

A new paper from the Office for Budgetary Responsibility .

It says UK health spending is set to rise in real terms by just 0.5% per year on average over the next four years.

That would mean real spending per head of population falling by 0.9% over that period.

Health spending, according to the report, is set to fall from 7.2% to 6.8% of UK national income.

Longer term, the OBR says, health spending will rise as a share of national income, given the ageing and growing population.

But, says the report: "This represents a key risk to the sustainability of the UK public finances."

With winter and the chancellor's Autumn Statement approaching, there will be more tales of woe and evidence of stresses and strains in the health service.

To some extent, it's a familiar refrain at this time of year, and the NHS has coped before despite dire warnings of trouble ahead.

But this year, the impact of rising demand and stretched finances seems to be more tangible and increasingly controversial.