“Firm action” is needed to tackle sliding performance against access targets, according to the latest quarterly report from the Department of Health.

The report said the NHS faced “significant challenges” due to winter pressures in October to December 2010. The period saw a number of trusts reporting deteriorating access.

It said the service “coped well” with the severe weather conditions and flu but there had been an impact on ambulance response times and accident and emergency waiting times.

It added there were “some concerns about performance against key access standards and firm action is needed to tackle poor performance and deliver improvement in delivering quality care to patients”.

The report also highlighted local variation in the achievement of cancer waiting times, although national performance against operating framework commitments had been sustained.

It identified 12 outlier organisations, including one that had only ensured 86.4 per cent of patients waited no longer than 31 days for cancer surgery against a target of 94 per cent.

Financial returns for the quarter show strategic health authorities and primary care trusts were forecasting an overall surplus of £1.269m, down from £1.286m at quarter two. This is 1.3 per cent of total revenue resources.

The report said: “This forecast surplus is in line with the revised operating framework and will help to provide a strong foundation as we move towards the end of this financial year and towards the crucial transitional year ahead.”