Published: 22/07/2004, Volume II4, No. 5915 Page 5

The NHS is celebrating its best ever year of star-ratings, with more three-star organisations than ever before.

But this year's results also reveal an increasing north/south divide in the quality of primary care, with the state of services in London singled out for particular criticism.

While 86 per cent of primary care trusts in the North have two or three stars, the figure in London is just 39 per cent. And the capital has no three-star primary care trusts at all.

The first ratings published by the Healthcare Commission show a general improvement for acute, specialist, ambulance and PCTs.

Overall 43 per cent of acute and specialist trusts now have three stars, up from 36 per cent last year.

Improvements in primary care were less dramatic. Fifteen per cent of PCTs got three stars - the same figure as last year - while the number of two-star trusts rose from 46 to 50 per cent.

But mental health trusts fared worse, with twice as many trusts as last year awarded no stars and only small improvements in the other categories. The commission attacked the quality of information which mental health trusts were able to provide.

The results will also re-start debate about the merits of the government's foundation trusts policy. Four current foundation trusts lost a star, along with 10 of the 30 trusts that had expressed an interest in winning foundation status in the next wave. The loss of a star will not impact on the current foundation trusts, but it gives those hoping to join future waves an uncertain future.

Within a national picture of improvement, there are some marked geographical trends, in particular with the state of primary care in London.

Healthcare Commission chief executive Anna Walker said a number of factors explained the absence of any three-star PCTs in the capital. As well as the difficulties in providing care to a 'mobile and mixed population', she flagged up 'particular problems on how these trusts are doing on MMR and smoking cessation targets'.

Ms Walker said the commission was keen to work with London PCTs to find out what they thought was behind the problems.

Other parts of the country witnessed radical transformations.

Last year Thames Valley strategic health authority had 10 zerostarred organisations. This year it has one, with the overall number of stars rising from 34 to 58.

Chief executive Nick Relph said the two factors which explained the dramatic turnaround were the 'incredibly hard work' to improve performance plus efforts to ensure a better quality of data was submitted.

He said: 'I think last year's ratings were a shock - we were devastated to see how we had done. We all agreed to come together as a community to better understand the data we were submitting and gear up our performance management.'

And he said part of the problem with the performance of organisations across the SHA the previous year was that 'as an SHA we were not focused on this adequately'.

Greater Manchester SHA saw its number of three-star organisations rise from three to eight.

Chief executive Neil Goodwin said the improved score - represented by an overall increase in performance rating of 23 per cent - was a huge achievement given that statistically Greater Manchester had the worst health in England, with the lowest life expectation.

He said the calibre of chief executives and managers across the patch had been key to improvements in performance.

Avon, Gloucestershire and Wiltshire SHA saw 12 organisations improve; nine stayed the same and just four dropped stars.

Director of performance Christina Craig said the results proved the SHA 'has turned the corner'.

Leicestershire Northamptonshire and Rutland SHA gained a threestar trust, four more two-star trusts and all three of its zerorated organisations moved up from the bottom rung.

Norfolk, Suffolk and Cambridgeshire SHA saw a massive drop in performance. Overall its total number of three-star organisations dropped from 12 to just two.

In a statement the SHA said:

'Last year we had more stars than any other SHA, so there was only one way to go. The balanced scorecard system is based on a comparison to other trusts across the country. So this year's figures do not necessarily mean we have got worse - It is more that others have got better.'

But the SHA admitted financial pressures were an important factor behind the loss of stars.