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.

Trusts have failed to hit targets for reducing MRSA and many are not meeting basic standards for hygiene and cleanliness.

Waiting times for operations and treatment have improved over the last year, the health check reveals.

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If middle managers don't manage and nurses are poorly motivated, no amount of money can solve the NHS's problems, says Michael White.

Already bruised by MTAS, junior doctors are now feeling the effects of market competition - but did the DoH bungle its workforce planning, asks Noel Plumridge, or did it know what it was doing all along?

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Uncertainty about the number of migrant workers in Britain means that planning for demand on local NHS services may become increasingly tricky, writes Alison Moore.

Getting users to shape a support service for young people was a tricky balancing act but worth the effort, writes Lizzie Neill.

Since commissioning at primary care level offers an unrivalled opportunity to shore up the foundations of the NHS, pitching in is the way ahead, suggests Andrew Jones.

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