There are significant variations in performance and facilities between trusts throughout Wales and a particular need to review critical care bed capacity as well as district nursing and diabetes services, according to the Audit Commission.

Its report on progress and value for money across Welsh NHS organisations also highlights a number of positive areas, notably the 'encouraging start' made by local health groups in terms of partnership working.

Drawing comparisons with primary care groups in England, it claims that 'LHGs appear to be developing at a steadier pace than PCGs across a broader front'. This steady pace in areas such as improving access and partnership working also has a downside in that LHGs have so far had little involvement in commissioning of services.

The commission recommends 'a clear strategic direction and leadership to help shape service delivery' in local health groups as well as in critical care and diabetes.

The report says that current critical care bed capacity is determined by availability of funding rather than by local demand, while some units have higher death rates than expected. It adds that 'demand is still often exceeding supply' while 'costs vary significantly between trusts with similar workloads'.

A Picture of Health? Audit Commission.Tel 0800 502030.