The Healthcare Commission said it would be a tougher test - and so it has proved. In the first national healthcheck ratings only two dozen organisations were rated excellent for service quality, and even fewer for their use of resources. Only half of NHS organisations met all the core standards, which clearly shows they are far from core for the NHS as a whole. Primary care trusts fared particularly badly.

The Healthcare Commission said it would be a tougher test - and so it has proved. In the first national healthcheck ratings only two dozen organisations were rated excellent for service quality, and even fewer for their use of resources. Only half of NHS organisations met all the core standards, which clearly shows they are far from core for the NHS as a whole. Primary care trusts fared particularly badly.

Meanwhile, what are the lessons for the new inspection process? The new system of self-declaration seems to have worked - the commission checked the scores submitted by about 25 per cent of all organisations and reduced the overall result for only 11 of them. Although about half had some kind of adjustment, in its first year that counts as a success both for the system and for the standard of trust board governance. Next year the bar for accuracy of self-declaration must be set higher.

There will be a public perception that NHS performance has taken a step back when compared with star ratings. Getting into the detail of the differences between the systems won't help with that one. In fact, it illustrates that wider truth that NHS organisations must constantly tell and re-tell their story locally rather than trying to react to big-ticket events like annual ratings which will put many of them on the back foot.

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