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The Department of Health and NHS England has been a happy place this month.

Confirmation that the A&E system in England met its four-hour target for the January to March quarter brought a quiet sense of satisfaction. After all, it was only a few months ago that a winter crisis was being predicted.

But has all that effort come at a price? The latest update on performance from the King's Fund suggests it might.

It notes pressure on non-emergency operations, such as hip and knee replacements, has begun to creep up. Treatment is meant to start within 18 weeks in 90% of cases.

This is being met, but only just as 90.4% of patients were seen within the timeframe in January. That is the lowest level for over two years.

If you measure it by average waiting time, it is even worse. It stands at 9.4 weeks, the worst it has been since the target was introduced in 2008.

Dig deeper and the situation gets even more alarming.

Winter is the time of year the waiting lists for routine treatments tend to shrink. But the numbers waiting rose by 20,000 from December to January.

It means compared with January 2013 there were an additional 362,000 people waiting for an operation.

This would be less of a problem if the NHS was increasing the number of operations to keep pace - something it has been very good at for the past decade.

But it isn't. The time to clear the waiting list (a measure of flows on to and off the list) is more than 11 weeks - the highest since May 2008.

Richard Murray, the King's Fund's director of policy, says this is concerning. "Hospitals have had to put their time and resources into A&E and with money so tight the concern is it might be difficult now to tackle this."

UPDATE THURSDAY

New data for February published by NHS England showed that the proportion of patients being seen within 18 weeks had dropped to 89.9% - breaching the 90% target.

It marks the first time it has been missed since early 2011.