Some trusts are disputing their annual health check scores as figures show many were highly over-optimistic about their performance.
More than two thirds of trusts the Healthcare Commission visited for the annual health check had their self-declared scores for core standards marked down by inspectors.
This resulted in 21 trusts having their overall quality of services score downgraded.
The core standard most likely to be downgraded concerned learning from patient safety incidents.
Price of optimism
But not everyone agrees with the commission's assessments, particularly those related to targets, which together with core standards make up the quality of services score. For example, 27 trusts failed to hit the choose and book target, including 11 foundation trusts.
Countess of Chester Hospital foundation trust deputy chief executive Jane Tomkinson said this was due to a "known technical issue, which meant that key data fields could not be recorded".
Ms Tomkinson also disagreed with the way the 18-week treatment target was calculated. Managers had told trust staff they had hit the target. "A straight fail proved demoralising," she said.
Chelsea and Westminster foundation trust's quality of services score was reduced from excellent to good because it missed the choose and book target.
Chief executive Heather Lawrence said a target related to delayed discharges was withdrawn from the assessment two weeks before the final scores were published, but no board director was informed.
"The exam question was altered after we sat the exam," she said.
The commission has also been quibbling with the Department of Health over how it measures the GP access target, which the annual health check showed 69 per cent of primary care trusts failed to meet.
The DH says the commission's interpretation of the data is wrong. It prefers to use figures based on the GP patient survey, in which 86 per cent of people said they could book appointments within 48 hours.
Only two appeals have been registered with the c regarding health check scores, although the closing date is not until 19 November. HSJ understands some trusts are considering group appeals.
A commission spokesperson said: "When people do poorly in an assessment, they sometimes seek to take issue with the test. But patients want trusts to concentrate on the issues the results raise. We would therefore urge trusts to respond to what the assessment shows."