National Health Service Trusts have generally turned in a pleasing performance for the year 2006/7, according to the Healthcare Commission’s Annual Health Check, with more scoring an ‘excellent’ or ‘good’ rating, and less falling in the ‘fair’ and ‘weak’ categories.

According to the report, which is now in its second year, overall Trusts are performing better than in 2005/6, with 19 scoring “excellent” on both quality of services and use of resources, up from just two last year.

And despite another year of service reorganisation, significant improvements were made in some areas, including: every Trust hitting the target for cancer patients waiting no more than a month from diagnosis to treatment (except for acceptable clinical reasons); A&E waiting time targets being met nationally, with 98% of 18 million patients getting care within four hours; and a greater number meeting the target of reducing the number of cancelled operations.

“This has been a tough year for the NHS, with significant reorganisation taking place, and tougher standards on infection control. Many trusts have stepped up to the challenge. They have delivered improvements in areas that really matter to patients, such as waiting times,” commented Anna Walker, the Commission's Chief Executive.

Room for improvement

On the downside, 33 Trusts were rated “weak” on quality of services and, of these, 20 scored “weak” on resource use too. In addition, the largest proportion of Trusts - 45% - were ranked as “fair” on quality of services, just five percent less than the prior year. The Commission expressed its disappointment that more Trusts did not move out of the “fair” category this year, and said it showed there was room for improvement.

Furthermore, Walker stressed that the evaluation of Trusts highlighted that were was also more to do on hygiene standards. “Forty-four hospital Trusts were non compliant with at least one standard,” she explained.

“The introduction of the government's hygiene code in October 2006 has helped organisations to focus on where they are still not doing everything that they should. The standards are much tougher in this area this year. This is how it should be for patients,” she concluded.

To help boost Trusts’ performance over the coming year, the Commission said it plans to work very closely with the Department of Health and the strategic health authorities to put in place action plans for those Trusts rated "fair" and "weak".

In addition, it says it will send out a team of inspectors into the Royal Cornwall Hospitals NHS Trust, because of its continued failure to meet standards, and will inspect the other 32 trusts deemed "weak" in the quality of services, to assess the problems and make recommendations for action.

Positive reaction

Reaction to the report has been largely positive. Health Secretary Alan Johnson said that it showed "clear improvement, with more trusts getting an excellent rating, more trusts improving on last year's performance and fewer in the lowest category."

"But we need to see more improvement from those classed as weak," he added.

British Medical Association Chairman Dr Hamish Meldrum said his organisation is “pleased that many NHS trusts in England have demonstrated an overall improvement in the quality of services and use of resources...Issues like quality of care, safety and waiting times are obviously very important to patients so it is heartening to hear that many NHS trusts are showing improvement in these areas.”

However, he also voiced concern that a number of Trusts are continuing to under-perform. “This is very disappointing news," he said, "and it is vital, for the sake of patients, that these under-performance issues are urgently addressed.”

The NHS Confederation also welcomed the findings and, looking to the future, its chief executive Gill Morgan singled out three key steps to drive further improvement across the country.

“First, we must see increased local autonomy for health professionals and staff to focus on local problems, not national directives. While targets can be useful, the days of the Department of Health trying to understand the needs of 60 million people are over. Second, the Service must be allowed to drive improvement without hugely damaging reorganisations that take time, resources and people away from patient care. The comparatively weaker performance of reorganised PCTs must be a wake up call. And third, the Annual Health Check shows that the best Trusts are improving at a faster rate than the lower performing Trusts. This means that we must invest in supporting all Trusts to ensure the spread of best practice and to drive up standards,” she stressed.