An NHS watchdog has told managers the health service must raise its game following a national review of performance revealed a mixed picture, with some trusts struggling badly.

Sir Ian Kennedy, chairman of the Healthcare Commission said although the audit had revealed good performance, including continued reductions in waiting times and significant successes in areas of public health, he said he remained concerned about poorly performing trusts.

For the first time, the health check included a systematic assessment across the NHS of whether trusts meet general standards, covering issues such as safety, cleanliness and quality of care.

Sir Ian revealed that by next year, he expected every patient to be entitled to a universal guarantee that general standards were met properly.

The commission rated 570 trusts in England on a four-point scale from excellent to weak for both quality of services and use of resources.

Results showed acute and specialist hospital trusts performing best. Half were excellent or good for quality of services and 30% were excellent or good for use of resources  although 42% were weak.

Fifty nine per cent of PCTs  whose role is increasingly to commission GP and dental services  were rated as fair for quality of service and 8% were weak. Just over 50% were fair for use of resources and 41% were weak.

Sir Ian said: "This is a tougher test for the NHS and we make no apologies for that. Trusts that held their hands up and admitted that they had some way to go on core standards deserve praise. This year's rating is a start of a journey."

He stressed: "On use of resources, the picture is not good enough, Some trusts have deficits, but many also have poor financial management systems."

But Sir Ian singled out two trusts that received excellent ratings in both categories: Harrogate and District NHS Foundation and the Royal Marsden NHS Foundation Trust, a specialist cancer centre.

He also pointed to 52 other trusts that performed particularly well across the two measures, scoring excellent or good against the tougher assessment.

He wants immediate action at 24 trusts found to be weak for both quality of services and use of resources. This group comprises 11 PCTs, eight acute hospital trusts, four ambulance trusts and one mental health trust.

The commission said strategic health authorities would be calling for action plans within the next month  and these SHAs would also be working with trusts rated as fair.

Both the BMA and the NHS Confederation have welcomed the new way of measuring NHS services  but believe constant health reforms are hampering efficiency.

Nigel Edwards, director of policy at the NHS Confederation, commented: "The spread of results across different types of NHS organisations is proof that the latest round of reorganisations has adversely affected services. Foundation trusts, who have not been reorganised and have extra freedoms to manage their own affairs, have been able to get on with the job and improve services as the health check shows."

Dr Jonathan Fielden, chairman of the BMA's consultants committee, said: "It is not surprising that PCTs have been shown as the worst performers when they have been subjected to constant reorganisation and restructuring. The NHS needs a period of stability to deliver the necessary improvements in care for patients.".

Health Secretary Patricia Hewitt declared: "The results confirm that more needs to be done to improve the performance of PCTs. I am confident that the recent mergers will results in further improvements."

The Best and Worst Performing Trusts

HIGH PERFORMERS

Two trusts, both foundation trusts, received a score of excellent for both quality of

services and use of resources:

Harrogate and District

The Royal Marsden

Twenty three other trusts were judged to have performed at a high level across the quality of services and use of resources scores:

Primary Care Trusts

West Hull PCT

Hastings and St Leonards PCT

Easington PCT

Ashton, Leigh and Wigan PCT

Bradford South and West PCT

Bromley PCT

Greater Derby PCT

Lambeth PCT

Mental health trusts

Dorset Health Care

North Essex Mental Health Partnership

County Durham and Darlington

South Essex Partnership

Cheshire and Wirral Partnership

Acute trusts Peterborough and Stamford Hospitals

South Manchester University Hospitals

Salford Royal Hospitals

Barts and The London

Doncaster and Bassetlaw Hospitals

The Newcastle Upon Tyne Hospitals

Northumbria Health Care

Derby Hospitals

University Hospitals of Leicester

POOR PERFOMERS

Twenty four trusts were rated weak for both quality of services and use of

resources.

Ambulance trusts

Avon Ambulance Service NHS Trust

Gloucestershire Ambulance Service NHS Trust

West Midlands Ambulance Service NHS Trust

West Yorkshire Metropolitan Ambulance Service NHS

Trust

Acute trusts

Barnet and Chase Farm Hospitals NHS Trust

Mid Cheshire Hospitals NHS Trust

Mid Yorkshire Hospitals NHS Trust

Northern Devon Healthcare NHS Trust

Royal Cornwall Hospitals NHS Trust

Surrey and Sussex Healthcare NHS Trust

West Hertfordshire Hospitals NHS Trust

Weston Area Health NHS Trust

Mental health trust

Buckinghamshire Mental Health NHS Trust

Primary care trusts

Bedfordshire Heartlands Primary Care Trust

Cheshire West Primary Care Trust

East Elmbridge and Mid Surrey Primary Care Trust

Guildford and Waverley Primary Care Trust

Kennet and North Wiltshire Primary Care Trust

North Somerset Primary Care Trust

Oldbury and Smethwick Primary Care Trust

Rowley Regis and Tipton Primary Care Trust

Swale Primary Care Trust

Watford and Three Rivers Primary Care Trust

West Wiltshire Primary Care Trust

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