Fifty NHS trusts ordered to take urgent action to halt their weak performances

Fifty NHS Trusts in England, almost one in 10 of the total, have been told to take urgent action to improve the quality of their services after the NHS watchdog branded their performance as "weak".

The worst performing trusts, ranked by the Healthcare Commission, include Moorfields Eye hospital in London which has an international reputation and the London Ambulance Service, the largest such trust in the country.

Twenty-four of these trusts also scored "weak" on financial management and have been ordered by their Strategic Health Authorities to produce action plans within a month setting out how they plan to improve. The commission said the performance of these trusts was "unacceptable". They include eight hospital trusts, 11 primary care trusts, four ambulance trusts and one mental health trust.

The criticism is contained in the first annual NHS "health check", which is published today and is being billed as the most comprehensive assessment of services ever. It reveals that England does not have a national health service offering the same standards to patients wherever they live, but a collection of local health services, some performing well but many performing below par and some very poorly.

Of the 570 trusts in England, the commission ranked 60 per cent (340) as "fair" or "weak" on the quality of their services. Just 230 were ranked "good" or "excellent" ­ 40 per cent of the total. The financial performance of the trusts was worse, with 210 ranked "weak " ­ 37 per cent of the total. The NHS ran up its largest ever deficit of £547m in 2005-06, the year to which the study relates, with one in three trusts in deficit.

The new ratings replace the old "star" system for ranking NHS performance, which was widely criticised for encouraging trusts to concentrate on hitting targets, such as cutting waiting times, while neglecting other aspects of their work.

The Health Check is both broader and tougher. Trusts were assessed on whether they were meeting 44 "core standards", such as treating patients with dignity and respect and providing nutritious food, targets for cutting waiting times and for tackling public health threats such as smoking and obesity. Separate assessments were made of their financial performance.

Opposition MPs used the findings to accuse the Government of mishandling the NHS. The LibDems' health spokesman Steve Webb said: "Patients will be horrified that so many hospitals are failing to achieve all of the basic standards in areas such as hygiene.

"Hospital managers should focus on getting the basics right, rather than being distracted by the latest headline-grabbing Government initiatives. This is a reality check for a Government which claims that NHS deficits are only a problem in a minority of cases."

Medical organisations said the results showed the damaging effect of NHS reorganisation. Primary Care Trusts, whose numbers have been cut by half through mergers in the last year, were the worst performers with more than nine out of ten ranked fair or weak and in need of improvement. Foundation trusts, which have extra freedom to manage their finances, performed best with 41 out of 48 scoring excellent or good.

Nigel Edwards, director of policy at the NHS Confederation, said: "The spread of results across different types of NHS organisations is proof that the latest round of reorganisations has adversely affected services. Foundation trusts, who haven't been reorganised and have extra freedoms to manage their own affairs, have been able to get on with the job and improve services."

Anna Walker, Chief Executive of the Healthcare Commission, said there were plenty of examples of good performance, with 52 trusts ranked good or excellent on both quality and finance. But she admitted: "The NHS does need to raise its game to ensure a universal guarantee that general standards on both quality of services and use of resources are being met."

A score of "fair" did not mean a trust was performing unacceptably but did mean that it needed to improve, she said. A trust scoring "weak" on quality of services needed urgent improvement, but did not threaten patients' safety.

However, there can be no delay in tackling the problems at the 24 trusts ranked weak on both quality and finance. "This level of under-performance is not acceptable," she said. "These trusts need to take immediate action to put the situation right.

Two trusts, the Royal Marsden cancer hospital in London and Harrogate district general hospital, ranked excellent on both quality of services and financial management, were "outstanding organisations", she said.

But Ms Walker admitted that, despite the increased sophistication of the health check, it would still not help a patient choose which hospital to attend for a hip replacement. "This is about the systems that underpin the services. We hope to publish [performance] indicators for individual services in the future."

Professor Sir Ian Kennedy, chairman of the commission said there were plans to include standards for cancer, stroke, heart disease and mental health services in next year's health check.

Details of individual NHS trusts performance are available at www.healthcarecommission.org.uk

Hospital ranked the best: Harrogate NHS FoundationTrust

The northern spa town of Harrogate, with its tea rooms and manicured gardens, is white, middle class and affluent. Its district general hospital, the 400-bed Harrogate NHS Foundation Trust, is the best DGH in the country, according to the Healthcare Commission. But does it deserve to be?

It ranked "excellent" on both quality of services and management of resources in the first annual healthcheck of NHS performance, published today. Only one other trust, the Royal Marsden in London, equalled its performance, although the Marsden is a specialist cancer hospital with the largest income from private patients of any trust in the country.

Located on a single site serving a largely well-educated, affluent population, Harrogate DGH does not face the same problems as large hospitals spread across several sites in more deprived parts of the country, such as Pinderfields in neighbouring West Yorkshire.

This highlights the weakness in any system of measuring performance in public services such as education and health. Is like being compared with like?

A spokeswoman put the hospital's success down to the high calibre of its staff and the contribution of the public who have signed up as members of the foundation trust.

However, she admitted that the level of community involvement in the trust reflected the highly educated and affluent population that it served.

Failings blamed on managers: Mid-Yorkshire NHS Trust

They may be only 30 miles south of Harrogate, but the three district general hospitals serving Wakefield, Pontefract and Dewsbury, which comprise the Mid-Yorkshire NHS Trust, are a world apart.

The trust is ranked among the eight worst hospital trusts in the country, scoring "weak" on quality of services and financial management. With 1,300 beds spread over three sites, the three hospitals cater to a poorer and more ethnically diverse population than in Harrogate. The area is a former mining community with high levels of respiratory disease.

The trust has a chequered history. Pinderfields hospital was put on special measures in December 2004 ­ one of only three to suffer this fate ­ after the Healthcare Commission uncovered failings in the gastroenterology department to respond to high rates of death and complication.

The problems were blamed on poor management "from the most senior level down". Special measures were lifted in May and the commission said there had been "major changes" to the service across the three sites.

In 2003-04 the trust ran up the largest debt of any trust. This year it has reduced its deficit to about £14.7m ­ still larger than most trusts.

John Parkes, the chief executive, said: "At the start of 2005-06, we were struggling to meet all of the national targets. However... we ended the year in a much stronger position."

Jeremy Laurance