Chiefs executives at the worst-performing trusts identified by the annual health check have hit back at the threat of takeover.

Health secretary Alan Johnson has asked health service chief executive David Nicholson to urgently meet the four rated weak’in both quality of services and use of resources for the second year running.

'If this is not satisfactory we will consider more radical action,' he said

'Stringent assessments would need to be made regarding the most appropriate course of action but one of the options could be takeovers by well performing Trusts.'

But chief executives at the beleaguered trusts this week defended their performance, highlighting progress not reflected in their overall health check scores.

Jac Kelly, interim chief executive at Northern Devon Healthcare Trust, said her trust had made 'dramatic' improvements in the last year under intense scrutiny from the commission, DH and health authority.

'The scrutiny and the support are in place,' she said. 'If there is more of that needed then we are more than willing to co-operate. But, to be honest, we think we have got the grip.”

John Watkinson, chief executive at Royal Cornwall Hospitals Trust, said it had also made great strides in its quest for 'long-term, sustainable improvement'.

Gail Wannell, chief executive ofSurreyandSussexhealthcare trust, said change took time:‘I will be telling David Nicholson to focus on the level of improvement we have made over the last year and ask him to give us realistic but challenging timescales.'

Professor Chris Ham, of the Health Services Management Centre inBirmingham, said takeover was not necessarily the best option.

It could work where trusts had struggled for many years such as when theGoodHopeHospitalinBirminghamwas taken over by the Heart of England Trust, he said.

'But if you’re talking about trusts which are not making improvements and have been struggling for a couple of years, they need another chance,' he added.

He said it would be more useful to look at ways high performers could support struggling trusts rather than take them over.