Annual performance ratings have revealed a persistent gap between high-flying trusts and those languishing in the bottom half of the tables.

The Healthcare Commission's annual health check 2006-07 shows an overall improvement in performance on last year, but more than half of trusts are still rated fair or weak - the lowest of the four categories - for financial performance and quality of services.

For the 'use of resources' financial performance measure, more than a quarter were weak, with the highest proportion (36 per cent) scoring fair. Last year, 37 per cent were weak and 47 per cent fair.

For quality of services, which looks at trusts' performance against national targets and 24 core standards, 8 per cent received a weak rating, compared with 9 per cent last year, and 45 per cent were considered fair, a drop of 5 per cent.

But the proportion rated excellent jumped this year from 4 to 16 per cent in quality of services and 3 to 14 per cent in use of resources.

The Healthcare Commission highlights reducing the divide between high- and low-performing trusts as one of the two main challenges arising from this year's assessment. A report accompanying the results says next year it will be 'spotlighting repeated poor performance'.

The second challenge is to move the bulk of trusts from fair, where most are now, to good ratings.

Commission chief executive Anna Walker told HSJ: 'It's about really good leadership and management. The capacity is there, it's about making it clear that areas such as infection control are a priority, and having processes in place so that everybody knows what they are. Next year we will work with Monitor and the strategic health authorities to performance-manage the 33 most poorly performing trusts.'

She said inspectors would be sent into Royal Cornwall Hospitals trust, which failed to meet three-quarters of the core standards.

Some trusts may have been marked down for use of resources despite sticking to their budget, due to historical deficits. Others simply needed to 'up their game', she said.

This is the first year that year-on-year comparisons can be made, after the annual health check was brought in last year to replace star-ratings.

The scores compare trusts' self-declarations with information from clinical audits, surveys and patient comments. Inspections may be carried out if inconsistencies are found, or at random.

This year, 85 trusts were inspected, of which 40 per cent were given a different score from their self-declarations. Primary care trust performance was poorest for the second year running, with reconfigured trusts' scores particularly low.

Mental health trusts did best, and were also the most improved sector in both categories. More than half were rated excellent for services, and 55 per cent were excellent or good for use of resources.

Acute trusts made significant improvements, with 19 per cent excellent for services - up 12 percentage points on last year. For resources, 28 per cent were rated excellent, a leap of 18 points.

For the second consecutive year, ambulance trusts failed to achieve a single excellent score.

The commission advises caution in comparing scores across different sectors, as different targets apply to each type. For example, mental health trusts face a narrower range of requirements than PCTs.

Next year, mental health trusts could face a tougher test, with extra goals for care plans and the number of people helped back to work. At present they have just one target, for crisis resolution teams.

Foundation trusts performed well, especially on resources. All 19 trusts scoring excellent for both parts of the rating - up from two last year - were foundation trusts.

Slightly fewer trusts scored weak for both ratings - 20 compared with 24 last year. However four trusts were in this category for the second year running.

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