A dozen of the country's supposed flagship NHS trusts were today told to improve or face action from health care regulators.
The Care Quality Commission (CQC) has unveiled a new registration scheme covering all 378 NHS trusts in England - but said 22 had improvement conditions imposed.
Twelve are NHS foundation trusts, the CQC said, including Mid Staffordshire and Basildon and Thurrock University Hospitals - both of which have been at the centre of care scandals in recent months.
Seven of them, including Basildon and Thurrock, have been told to make urgent improvements.
Under the new registration scheme, the CQC can impose fines, launch prosecutions or suspend services at failing trusts. Previous regulators have only been able to urge ministers to take action.
Cynthia Bower, CQC's chief executive, said: "Most conditions were imposed in relation to the care and welfare of people who use services.
"This makes clear that some trusts must do more to make sure people experience effective, safe and appropriate care that meets their needs and respects their rights."
She added: "We will now be monitoring these trusts constantly, carrying out more unannounced inspections and using our tough new enforcement powers to make sure people get better care."
Foundation trusts were created in 2004, and gave more control to local management teams.
Held up by the Government as being at the "cutting edge" of health care, they have to show they are financially viable and provide better services in return for the extra freedom.
Around 130 NHS trusts have been given foundation trust status since the scheme was launched.
Patients' groups said the number told to improve raises questions about their flagship status.
Katherine Murphy, director of the Patients Association, told the BBC: "Foundation trusts are meant to be the premier league of the NHS. But these results call into question the assessment process and actual status.
"We believe there is too much emphasis placed on financial performance rather than quality of care. The foundation trust regime needs looking into."
The seven foundation trusts told to make urgent improvements are: Basildon and Thurrock University Hospitals NHS Foundation Trust; Heart of England NHS Foundation Trust; Heatherwood and Wexham Park Hospitals NHS Foundation Trust; Medway NHS Foundation Trust; Peterborough and Stamford Hospitals NHS Foundation Trust; Sherwood Forest Hospitals NHS Foundation Trust; and Tameside Hospital NHS Foundation Trust.
The five others with conditions are: Luton and Dunstable Hospital NHS Foundation Trust; Northern Lincolnshire and Goole Hospitals NHS Foundation Trust; Surrey and Borders Partnership NHS Foundation Trust; Mid Staffordshire NHS Foundation Trust; and Milton Keynes Hospital NHS Foundation Trust.
Mid Staffordshire was subject to an independent inquiry which earlier this year found that patients were subject to "unimaginable suffering" by staff.
Appalling standards put patients at risk and between 400 and 1,200 more people died than would have been expected in a three-year period from 2005 to 2008.
A report into Basildon and Thurrock also found higher-than-expected death rates among patients and poor standards of hygiene.