In what has been described as the most rigorous assessment of NHS trusts to date the Care Quality Commission’s annual performance rating has shown that while more are achieving higher overall standards a significant number are persistently failing to hit targets.

According to the CQC, which took over from its predecessor the Healthcare Commission earlier this year, PCT’s earned better results overall than ever before with more than half of the 392 currently operating in the country achieving scores of ‘excellent’ or ‘good’ for the first time.

In addition, it seems that trusts are getting better at controlling spending, with “a significant improvement” seen in ratings for financial management, which is particularly encouraging given that the health service is facing a financial drought over the coming years as the government freezes budget increases.

The Commission also highlighted notable achievements in increasing the number of patients (98%) seen in A&E departments within four hours of arrival and the number receiving hospital treatment within 18 weeks of being referred by a GP, as well as greater Chlamydia screening and a big reduction in the notorious suberbugs MRSA and Clostridium difficile.

And an impressive 37 trusts were rated double-excellent, including The Royal Marsden NHS Foundation Trust, which has achieved this score for the fourth year running. Barking, Havering and Redbridge University Hospitals NHS Trust was the only one to be rated double-weak, but last year six trusts were scored as such, showing a marked improvement this year.

However, the Commission said it was concerned over the 20 trusts voted ‘weak’ and the further 27 that have not managed to score above ‘fair’ on Quality and Financial Management in the last four years, stressing that these will face a ‘tough’ challenge to meet requirements of the new registration system due for introduction in April next year, after which all trusts must be registered in order to legally function.

And highlighting other areas in need of improvement, the CQC criticised the 63,000 operations that were cancelled during the year for non-clinical reasons and the fact that just 37% of acute trusts were up to scratch on stroke care. In addition, it said while progress has been made in the fight against hospital-acquired infections acute trusts must get better at infection control, with 48 failing on at least one of the three relevant standards compared to 44 last year.

Commenting on the findings, CQC chief executive Cynthia Bower said the NHS has performed well on quality, which is “good news in the face of a rigorous assessment”, but, she added, “it is clear that some trusts are struggling and that some issues are proving tough nuts to crack”.

“My biggest concern is those trusts that are ‘weak’ and persistently ‘weak’ or ‘fair’…I want to ring the alarm bell in the boardrooms of these organisations,” she said, and warned: “Next year, all trusts must register with us to legally function. It is clear that many have significant work to do and a short time in which to do it.”

Understanding the problem
Also commenting on the results, Niall Dickson, chief executive of think-tank the King’s Fund, argued that: “Patients served by the hospitals and other services that consistently rank at the bottom have a right to know why these organisations are not providing the quality of services that is expected from them. We need to understand whether the problems are managerial or structural, and what is being done to help them raise their game”.

And he pointed out that the current performance “has been achieved in a period of funding growth – the big challenge going forward will be to maintain and improve those standards when money is tight”.

Steve Barnet, chief executive of the NHS Confederation, also stressed that with the NHS entering the most demanding period of financial pressure in its history the reasons why some trusts are consistently scoring under par need to be understood “if the performance of the best trusts is to be reflected across the whole of the system”.

“These figures provide leaders in the NHS with a focus on where they can do better in the year ahead and highlight where improvements need to be made – the challenge is to make sure that they are,” he stressed.