More than half of NHS organisations are now providing excellent or good services, according to the third annual health check.

But the annual assessment scores, published today by the Healthcare Commission, expose a widening gap between the performance of steadily improving trusts and floundering commissioners.

The proportion offering excellent services has leapt from 4 per cent to 26 per cent since the first assessment in 2005-06.

Widening gap

Acute trusts have improved steadily since the first assessment, with the number of good and excellent scores rising from 54 to 77 per cent.

Mental health trusts have achieved 91 per cent compared with 40 per cent two years ago. For ambulance trusts, the figures have increased from 40 per cent to 63 per cent.

But more than two-thirds of primary care trusts are rated fair or weak.

The PCT figure has remained stagnant since the first annual health check in 2005-06 and is more than twice the proportion in any other part of the health service: 36 per cent of ambulance trusts, 23 per cent of acute trusts and 9 per cent of mental health trusts were given the lowest two ratings.

The quality of services score is based on assessments against targets and core standards, set four years ago as the bare minimum that patients should expect.

Access, convenience and choice

Healthcare Commission chief executive Anna Walker told HSJ: “There has been very significant improvement in NHS performance over the last three years.

“What has pulled PCTs down is GP access, convenience and choice. All our work suggests there are some real issues.”

The lack of improvement among PCTs has meant that in the past two years, the difference between the proportion of PCTs providing good and excellent services compared with the best performing sector, mental health, has increased eightfold.

In 2005-06, the two sectors were separated by just seven percentage points - now it is 58.

PCT Network director David Stout said PCTs needed to “pick up the pace” of improvement but pointed out that they were assessed against a much wider range of standards and targets than others.

“Changes to the health check next year will help as we’ll be able to distinguish between the performance of PCTs’ commissioning and provider arms,” he said.

The stubborn tail

The proportion of PCTs achieving standards related to access to GPs has dropped from 95 per cent in 2005-06 to 31 per cent in 2007-08. The Healthcare Commission says this is partly due to more sophisticated measurements that have led to a more realistic assessment.

Less than a third of PCTs met expectations on choose and book and only 27 per cent hit an indicator on patients being offered a choice of hospital.

Ms Walker criticised the “stubborn tail” of NHS organisations failing to comply with the full set of core standards, which was true of 17 per cent.

She said: “The Department of Health, and certainly the strategic health authorities, are going to be asking for action plans from those trusts. We plan to look in about three months at the work going on.”

Capital performance

Relatively poor performance in Londoncompared with the rest of the country was a concern, as was the lack of improvement on the hygiene code.

Six trusts scored weak in both quality of resources and use of resources, which assesses financial management, and for non-foundation trusts is based on Audit Commission ratings.

Overall, scores were similar across the two parts of the health check. The commission sees this as evidence that trusts are not prioritising finance over quality.

Ninety per cent of foundation trusts scored excellent for use of resources, with only one foundation trust, Royal National Hospital for Rheumatic Diseases, rated as fair. None were weak.

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*081016 health check