A perfect storm is brewing for the NHS and hospitals as they emerge from coronavirus pandemic
The NHS Confederation's warning that the health service could have waiting lists of up to 10 million might sound alarmist but it's probably not way off.
The service went into this pandemic under considerable strain because demand was so great; targets were being missed, even cancer waiting times weren't good.
Since then, staff have effectively had to press the "pause" button while they deal with huge numbers of Covid-19 patients and reconfigure their whole hospital in order to keep non-coronavirus patients safe.
Pressing pause has meant operations were cancelled, non-urgent treatments postponed and routine check-ups delayed.
NHS England has announced hospitals must now try to resume some of their other services but of course that means there's a huge back log of patients to get through, no surprise there.
Ann Broughton, Matron at St George's Hospital in Tooting, south London, describes the mental exhaustion of staff after dealing with Covid-19, but also their determination to keep going
But that is not all, as well as having to deal with a backlog of cases, NHS Confederation points out there will be thousands of patients sitting at home who should have gone to hospital in the last three months and didn't because of fears of catching coronavirus.
It's those people who will now need treatment and perhaps more longer term treatment because whatever their illness, it might be worse now than it was then.
So far, so worrying. But there's more.
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Coronavirus itself has affected hundreds of thousands of people, many of whom will now need long term care and support perhaps for many months and years, and then there's the fear of a second wave of the virus, which could spike at any time and require hospitals to jump to it once again.
All this on top of hospitals having to ensure social distancing is respected - so capacity will be lower anyway as well as being driven by a team of people who are exhausted, over worked and in some cases traumatised by the last three months.
Dr Sarah Jolly, Emergency Medicine Consultant at St George's Hospital, says it's foolish to deny there's concern over what's to come, with a potential second wave, cancelled operations, patients with serious conditions avoiding hospitals and a looming winter crisis
Raising all these concerns then for the NHS Confederation is simply, it says, their duty and is the responsible thing to do.
CEO, Niall Dickson, warns that we will all have to lower our expectations of the NHS in the coming months.
He also wants more funding from the government to help deal with the growing problems.
The Department of Health has committed to providing all the funding and resources the service needs and says they've issued detailed guidance on how to restart services safely.
Chief Executive of NHS Confederation, Niall Dickson, says we should be very worried about the backlog the NHS will face after this pandemic
Medics I have spoken to at one of London's busiest hospitals, St George's, are all too aware of the future ahead of them.
Every single person I spoke to was immensely optimistic they can cope but the cracks showed.
They spoke of being exhausted, they couldn't deny everyone needed a break and they admitted constant planning and re-planning was stressful.
But it is what they do, they said, they are used to pressure and trauma and support networks were in place to help them.
I hope so, because a perfect storm is brewing for the NHS and hospitals will need all the optimism in the world to get through it.