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The NHS in Wales is "starting winter in a more difficult position" this year, the body representing the country's health boards has said.
Vanessa Young, director of the Welsh NHS Confederation, said the growth in funding for the NHS was less than in previous years and it also faced "workforce challenges".
Her comments come after four of Wales' seven health boards said they had to cancel routine operations, due to the pressure on their services.
The Welsh Government has said it planned several months in advance to cope with winter strains on the NHS, supported by 拢50m in funding to help balance emergency and planned activity.
The chief executive of NHS in Wales, Dr Andrew Goodall, has apologised to patients whose routine operations have been postponed due to "exceptional levels of demand" on the service in recent days.