The stroke target, winter pressures and the increasing number of foundation trusts are being blamed for the slide in acute trusts’ annual health check performance.

The proportion of acute trusts rated good and excellent for service quality in the annual health check dropped by 9 per cent between 2007-08 and 2008-09, while compliance with core standards fell by 14 per cent.

In many cases they’re failing very narrowly by decimal point failures on targets when their underlying performance hasn’t shifted that much

Care Quality Commission chief executive Cynthia Bower attributed the decline partly to more realistic self assessments.

Analysis by HSJ shows 65 acute trusts received a lower rating for quality of services this year, of which more than half (33) had foundation status.

Birmingham University professor of health policy and management Chris Ham said newer foundations not yet in the NHS “premier league” were spending a lot of time meeting annual health check requirements while having to “jump through hoops” for Monitor.

He said: “There are so many standards and targets trusts have to abide by. In many cases they’re failing very narrowly by decimal point failures on targets when their underlying performance hasn’t shifted that much.”

Winter pressures last year had brought “a real spike” of accident and emergency attendances leading to many trusts missing the four hour waiting time target, he added.

Of the 65 acutes that performed worse this year, 30 moved from excellent to good, 26 from good to weak and three from fair to weak. Four dropped by two grades, from excellent to fair, while two fell straight from good to weak.

The core standards they were most likely to fail included safeguarding children, decontamination, safe use of medical devices, clean, well designed environments and consent.

Worcestershire Acute Hospitals Trust chief executive John Rostill said his trust slid from good to fair despite increasing compliance with the A&E target from 96.5 per cent to 97.6 per cent. He said in previous years the Department of Health had “rounded up” the percentage.

But he admitted: “We’ve known about it for a year so that’s a wimpy excuse.”

A shortage of radiologists meant the trust struggled with the two week cancer wait target. It also missed the target for the time patients spend on a dedicated stroke unit.

A DH spokesperson said that assessment was more challenging this year so comparisons with last year had “very limited value”. Changes to the indicators and methodology had affected performance on core standards.

But the CQC denied this year’s acute assessment was harder, saying indicators had only changed as much as in years in which results improved.