Just two organisations, both of them foundation trusts, have scored top marks in the first healthcheck ratings by the Healthcare Commission.

Just two organisations, both of them foundation trusts, have scored top marks in the first healthcheck ratings by the Healthcare Commission.

Harrogate and District and London's Royal Marsden were both rated excellent for quality of care and use of resources under the new dual system of assessment.

But many organisations performed poorly under the new system, which the commission claims is the 'most comprehensive assessment yet of NHS performance'. In particular, performance was poor in the use of resources category, which covers areas such as financial management, control and value for money.

Of 570 NHS organisations in England rated on a four-point scale from excellent to weak, just 24 (4 per cent) scored excellent for their quality of services, indicating they performed well on all 24 core standards and all national targets.

In the same category, 172 (30 per cent) scored good; 296 (52 per cent) fair and 78 (14 per cent) weak. On use of resources, only 19 organisations (3 per cent) - all foundation trusts - scored excellent, with 71 (12 per cent) good, 270 (47 per cent) fair and 210 (37 per cent) weak (see table).

Under the new system, quality of services covers performance against minimum standards, existing targets, progress on new targets, improvement reviews and the acute hospital portfolio.

The findings came from self-assessment by trusts, with 10 per cent subject to spot-check, while 15 per cent were 'challenged' after an anomaly was identified by the commission. Just 11 trusts had their rating reduced as a result.

Use of resources examines financial management, control, value for money, standing and reporting, with scores based on ratings provided by the Audit Commission, and, in the case of foundation trusts, Monitor.

In total, 33 trusts were rated weak for both their quality of services and use of resources. Overall, 51 per cent of trusts did not 'fully meet' the core standards and nearly two-thirds did not fully meet national targets.

Organisations were deemed to have fully met the standards if they achieved 20 of the 24, and committed to achieve the remainder within 12 months.

Primary care trusts performed worse than acute and specialist trusts, with 20 rated weak on both measures. No PCT got an excellent score for use of resources and only six of 303 PCTs were rated excellent on quality of services.

Commission chief executive Anna Walker defended the NHS's performance, saying this was a new, tough regulatory regime. 'We would have been concerned that we hadn't made it tough enough if every trust passed,' she said.

'For the 14 per cent of trusts that have failed on quality of services, no this is not good enough,' she added. 'But the vast majority are in the &Quot;fair&Quot; category. This is a tough test and as far as we are concerned what matters is that every trust looks to see where it is not meeting standards and taking steps.'

She praised the achievement of the third of trusts that were rated good or excellent for their quality of services.

The new annual health check replaces the star-ratings and Ms Walker was anxious not to make a comparison between results under the two systems.

However, she said clear improvements had been made by the NHS in the last five years. For example, waiting times had dropped dramatically, especially for inpatients and in accident and emergency.