The wealth of data unveiled today by the Healthcare Commission in its annual trust health check reveals foundation trusts are thriving, primary care trusts are struggling, and the best are leaving the rest behind.

While there is evidence of migration towards excellence, more than half of trusts are still rated fair or weak for quality of service, and the number in the latter category has barely moved since last year.

But the news on use of resources is worse, with 62 per cent of trusts in the bottom two categories.

A total of 19 trusts scored double excellent ratings, but four trusts scored double weak for the second year running.

Monitor can take heart from the success of foundation trusts, particularly in their use of resources. The selection process for foundation status seems to be picking winners.

Mental health trusts - admittedly with fewer indicators to hit - performed best, while primary care trusts languished at the back of the pack for the second year.

The wreckage left by the reorganisation of PCTs is plain to see, with those that were merged last October struggling across the spectrum of performance measures - but many that were left untouched were also in difficulties.

The consequences of PCT under-performance could be profound. PCT Network director David Stout issued a stark warning last week that they risk being stripped of their commissioning powers if they do not raise their game (for more background, click here).

The Department of Health has promised to deliver 'world class commissioning'. The health check data casts doubt on whether PCTs are the vehicle to achieve this. Strategic health authorities need to act quickly to help PCTs develop the management capacity they so badly need.

For more HSJ coverage of this year's health check, click here

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