England’s 319 National Health Service (NHS) Trusts are improving the quality of services and managing money more effectively, according to the third Annual Health Check performance ratings published today (October 16) by England’s independent health watchdog, the Healthcare Commission. However, the performance of Primary Care Trusts (PCTs) overall is disappointing, it says.

In terms of quality of services, the Commission this year judged 100 NHS Trusts (26%) to be “excellent,” 139 (36%) “good,” 132 (34%) “fair” and 20 (5%) “weak.” Two years ago, 41% were excellent or good, while 59% were fair or weak.

For their use of resources, this year 94 Trusts (24%) were “excellent,” 145 (37%) were “good,” 132 (34%) were “fair” and 20 (5%) were “weak.” Two years ago, just 16% were excellent or good, while 84% were fair or weak. Overall, 42 Trusts were “excellent” on both measures this year, compared with two in the first annual health check in 2005-6, while the number scoring “weak” on both measures has fallen from 25 to six.

By type of Trust: - England’s 169 Acute and Specialist Trusts were the most dramatically improved; - PCTs’ performance disappointed overall, with only 33% rated “excellent” or “good” on quality of services, although this year also sees Salford PCT become the first ever double-excellent PCT; - Ambulance Trusts are starting to deliver against challenging targets for times of response; - Mental Health Trusts performed better than other types, although the assessment includes fewer targets and so is less demanding; and: Foundation Trusts continued to outperform.

The results show a real shift in performance, with waiting times for cancer treatments having come right down and ambulances responding faster than ever to calls in life-threatening situations, said the Commission’s chairman Sir Ian Kennedy.

However, 114 Trusts failed to meet one or more of the three core standards relating to infection control, up from 111 last year. In addition, only 52% of Acute Trusts met the target to reduce rates of Methicillin-resistant Staphylococcus aureus (MRSA) by at least 60% over three years (or a maximum of 12 cases of infection). “We are a lot closer to getting core standards in place across the NHS but there are still too many Trusts that are not there. It’s very satisfying to see MRSA rates falling overall but the challenge posed by these infections remains. Some Trusts are still not doing all that’s necessary to sustain the drop in rates of infection,” said Sir Ian.

Regionally, north of England Trusts performed best, on both quality of services and use of resources, for the third year running, but those in the southwest delivered most improvement.

London was the only area of the country where performance for quality of services declined, with 48% scoring “excellent” or “good,” compared to 55% last year. For the first time, there is a gap between London and the rest of England, and the areas of concern centre on access to services, accident and emergency (A&E) waiting times, access to GPs, waiting times from referral to treatment and screening for breast cancer, says the Commission. Action to address these issues should focus on encouraging PCTs to work together to commission services, improving access to GPs and reconfiguring hospital services where this would benefit patients, it adds.

Generally, Trusts performed well against government targets relating to waiting times for cancer treatment, and good progress is being made in meeting the target to treat all patients within 18 weeks of referral. However, there was a dramatic decline in the number of PCTs meeting the target that every patient should be able to see a GP within two working days - down to 31% this year from 80% last year - and only 16% of PCTs achieved the target on provision of convenience and choice.

“PCTs have not performed as well as other parts of the NHS but there has been a marked improvement in their ratings this year,” said David Stout, director of the PCT Network which represents the vast majority of PCTs. He also pointed out that PCTs are assessed more rigorously than other parts of the NHS, so comparing across sectors is not always totally fair.

Steve Barnett, chief executive of the NHS Confederation, which represents over 95% of NHS organizations, welcomed the results and called for the Annual Health Check to move now to focusing on patient outcomes and experience, while Sue Slipman, director of the Foundation Trust Network (which is part of the NHS Confederation), described the results as “a roll call of excellence for Foundation Trusts” which confirms that this model “is leading the way in delivering for patients.”