The majority of primary care trusts are meeting only “minimum requirements” in their use of resources, the results of the Audit Commission’s annual test have shown.

But all other trusts have continued to improve, with 93 per cent meeting or exceeding minimum requirements and 69 per cent performing “well” or “strongly”, compared with 49 per cent in 2007-08. Seven out of the nine trusts that failed have known problems and have failed for the past four years.

There were major shortcomings. We have a hell of a lot to do in Buckinghamshire

Ed Macalister-Smith

Audit Commission head of health Andy McKeon said the proportion of trusts scoring highly was particularly striking given the fact that the best performers had become foundation trusts and so were no longer included in the assessment.

But PCTs scored less well. In the first year of a new “use of resources” assessment, PCTs were given scores for their financial management, governance and management of resources.

They scored best on their financial management, with the majority (53 per cent) scoring above minimum standards.

But the vast majority of PCTs - more than 70 per cent - met only the minimum requirements in the governance and management of resources tests. Seven failed the management of resources test overall and no PCT scored an “excellent” in any of the three main areas.

Mr McKeon said the commission had consciously set a tougher test than previously.

But he said PCTs had “real work to do” in their workforce planning and development. Eight PCTs failed in that part of their assessment and most - 119 - meet only “minimum requirements.”

The commission’s report said weaknesses included the absence of any workforce plan, the lack of “ownership” of workforce issues, and the absence of workforce productivity measures and benchmarking.

Mr McKeon said there was also a “relative weakness” in data and in “real knowledge about what community services are being provided and at what cost”.

PCTs are supposed to be reviewing their provider arms under the Transforming Community Services programme. But Mr McKeon said that was “in the first instance a structural agenda, so [that] tends to dominate the discussion rather than productivity”.

He said PCTs needed to prioritise that productivity, particularly as community services are not under the national tariff so there was “no one else” but the commissioners to drive down prices.

Although no PCT scored “excellent” on any of the three overall areas, 11 were rated as “performing well” (see table).

Only one PCT - Buckinghamshire - failed in all three areas. The PCT’s chief executive Ed Macalister-Smith told HSJ its low scores were on the whole an accurate reflection of how it was performing 18 months ago.

He said the PCT had since improved a number of its processes but, as the Audit Commission’s inspectors had wanted to see evidence that such processes were operating during the whole financial year, Buckinghamshire had inevitably failed.

Mr Macalister-Smith said: “Several issues weren’t being addressed [at the PCT]. There were major shortcomings. We have a hell of a lot to do in Buckinghamshire.”

He said a major issue had been the “unresolved” merger of three PCTs into one, which meant that as late as 2008 it was still running three separate governance structures.

Although the PCT had made improvements, Mr Macalister-Smith said that its £7.5m deficit complicated matters: “Making an investment in commissioning capacity is a sensitive thing to do when you are an organisation in deficit.”

The 11 PCTs that are performing well across the board

  • Barnsley
  • Bolton
  • Bromley
  • Islington
  • Knowsley
  • Lambeth
  • Redbridge
  • Salford
  • Sheffield
  • South Staffordshire
  • Westminster

PCTs failing in one or more areas

  • Buckinghamshire
  • Bath and North East Somerset
  • Central and Eastern Cheshire
  • Enfield
  • Halton and St Helens
  • Peterborough
  • South Gloucestershire
  • Western Cheshire

Nine acute trusts failing to meet minimum standards

  • Barking, Havering and Redbridge Hospitals*
  • Bromley Hospitals*
  • Buckinghamshire Hospitals
  • North West London Hospitals*
  • Queen Elizabeth Hospital*
  • Queen Mary’s Sidcup*
  • Trafford Healthcare*
  • West Middlesex University Hospital
  • Whipps Cross University Hospital*

*failing for the fourth year running

HSJ’s NHS Performance Management conference is on 24 November, www.hsj-performance.com