THE NHS is “holding up well” at a national level but there are significant pressures in some organisations, according to a new report.

The study, from the King’s Fund, said national figures for waiting times and infection rates masked variations in performance between hospitals.

The 18-week target is being breached by a significant number of trusts, while 10% of hospitals do not see A&E patients within four hours, despite 97% of all patients nationally being seen in this timeframe.

And while levels of hospital infections such as MRSA and Clostridium difficile (C. diff) have reached an all-time low, 45 hospital trusts have reported higher levels of C. diff than in the same period last year.

There are also concerns about the Government’s efficiency drive, with trusts tasked with finding up to £20bn in savings.

A King’s Fund survey of 23 finance directors for this quarter found eight were either “concerned or very concerned” about meeting productivity targets for 2011/12, while four were uncertain.

Twenty thought the measures would not harm clinical quality, while three were uncertain and 15 expected to end this year in financial surplus.

Professor John Appleby, chief economist at the King’s Fund, said: “While the NHS continues to perform well, a minority of trusts are struggling.

“Looking ahead, the challenge will be to maintain performance and deliver productivity improvements as finances tighten further.

“Six months into an unprecedented four-year period of financial restraint, the pressures already emerging in a small number of trusts highlight the scale of the challenge facing the NHS.”