Britain's health care improves but London's is getting worse

Its hospitals are among the greatest in the world, attracting patients from around the country and across the globe. Yet London's health service is getting worse while the NHS in the rest of the country is rapidly improving.

Full local data on Health Care Commission's website

The annual NHS performance ratings, published today, show the capital, which historically has had the lion's share of NHS resources, is the only area of the country where the quality of services declined in 2007-08. Fewer than half its NHS trusts (48 per cent) scored "excellent" or "good", compared to 55 per cent in 2006-07.

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Anna Walker, chief executive of the Healthcare Commission, which published the ratings, said for the first time they showed a gap between London and the rest of the country. Only 16 per cent of London NHS trusts rated excellent for quality, compared with 28 per cent elsewhere. "London faces major issues," she said. "It is an international city and the population is constantly moving. Its reputation as a centre of excellence is not threatened but basic medical issues have brought performance down."

The biggest problem for Londoners was gaining access to its world-beating services. Patients faced difficulties getting GP appointments within 48 hours, longer delays in A&E, slower referral for treatment and poorer access to screening for breast cancer.

Ms Walker said the capital was short of GPs and some primary care trusts (PCTs) were too small. "NHS London is right to encourage PCTs to work together and there may be a case for reconfiguring services," she said.

Performance ratings for all 391 NHS trusts in England show a big improvement on two years ago, when they were first published, with 60 per cent rated good or excellent in 2007-8 compared with 60 per cent fair or weak in 2005-6.

But pockets of poor performance remain. Despite two years of focus on the threat of superbugs such as MRSA, 60 per cent of trusts failed one or more core standards relating to infection control or missed their MRSA target.

Last month ministers hailed the NHS's success in curbing hospital infections after figures showed the three-year target to cut MRSA rates by 50 per cent had been achieved. But the figures hid variations between trusts, with some reducing MRSA infections to near zero while others recorded scores of infections. Almost half of hospital trusts (48 per cent) underachieved or failed to hit their MRSA target, the Healthcare Commission said.

The report reveals an apparent dramatic decline in access to GPs, with the number of PCTs meeting the 48-hour target for an appointment down to less than a third (31 per cent) compared with 80 per cent in 2006-7.

Results from patient surveys were included for the first time this year which sharply reduced the figures obtained from GPs surgeries. Officials said it was impossible to tell whether the discrepancy was due to GPs "playing the system" or to patients ignorance of the rules governing 48-hour access.

Ms Walker said: "Patients feel GPs are listening and provide good care [but] it is frustration with access to a good service that is the problem."

Sir Ian Kennedy, chairman of the Commission, defended the use of the ratings to improve performance. "What gets measured, gets done," he said.

Primary care trusts: The best – and worst

Top five trusts:

* The Royal Marsden

* Salford Royal

* Cambridge University Hospitals

* Frimley Park

* Sheffield Teaching Hospitals

Bottom five trusts:

* Scarborough and North East Yorkshire

* North Yorkshire and York Primary Care Trust (PCT)

* Gt Yarmouth and Waveney PCT

* Royal National Orthopaedic Hospital, London

* Brent Teaching PCT cm4

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