NHS trusts in rural areas are among the worst in the country for providing good patient care, a report by the healthcare watchdog suggests.

The performance of health service organisations appears to be improving overall but the medical postcode lottery continues to create regional variations in the quality of services, the Healthcare Commission says.

Large expanses of the South East and West of England, in particular, have services rated as “weak” in an important new report.

The watchdog’s Annual Health Check, published today, also reports that one in four trusts across the country is still failing to meet basic standards of hygiene and infection control.

The report provides individual ratings for nearly 400 NHS hospitals, primary care trusts, mental health and ambulance services in England.

Patients can check whether their local health service bodies have achieved scores of excellent, good, fair or weak for both quality of clinical services and financial performance.

Of the 33 trusts rated weak for the quality of services – an overall measurement of patient care – the vast majority serve rural counties, including Yorkshire, Devon, Cornwall, Surrey, Sussex, and Hertfordshire.

The North East had by far the highest combination of trusts rated either excellent (13 per cent) or good (61 per cent), while one in four trusts in the East Midlands was rated excellent for quality of services.

One in five trusts in the South West was considered weak, making it the worst area for this category, while the South East had the lowest proportion of excellent trusts, with only 8 per cent in that category, as well as the highest combination of fair (58 per cent) and weak (19 per cent) trusts.

The Royal Cornwall Hospitals NHS Trust was judged to have the poorest record of all, meeting only 25 of the 44 core standards.

Primary care trusts (PCTs) – the local NHS bodies that plan, organise and pay for care – remain overwhelmingly the weakest part of the system, with fewer than 20 per cent regarded as good or excellent. Strikingly, PCTs that have recentlybeen reorganised to cover larger areas have rated more poorly than others on quality of services, suggesting that NHS reorganisations have damaged patient care.

A quarter of all trusts are not complying with at least one of the three core standards on infection control, the report concludes. A total of 111 trusts out of the 394 assessed – 44 of them acute and specialist hospitals – were found not to have complied with one or more of these standards.

In addition, trusts are not making progress on the reduction of MRSA and the ratings do not measure rates of Clostridium difficile.

The full ratings for the 394 NHS trusts in England can be found online at www.healthcarecommission.org.

Overall, 19 NHS trusts scored “excellent” on both quality of services and use of financial resources – up from only two last year. They were all “foundation” trusts, which exercise more control over their budgets.

On quality of services, 16 per cent of trusts were “excellent” and 30 per cent were “good”. But the commission noted “with concern” that 33 trusts (8 per cent) were rated “weak” on quality of services. Of these, 20 were also rated “weak” for use of resources.

The watchdog said that it was concerned that the largest group of – 45 per cent – fell into the category of “fair” on quality of services, meaning that their performance was adequate but there was room for improvement.

Alan Johnson, the Health Secretary, called for more progress in the worst-performing areas but said that patients should not regard weak trusts as unsafe. On hospital infections, he said: “The standards set for hygiene compliance are tough and, following the new statutory hygiene code, have been harder in the last year as we have raised the bar higher.”

Top of the trusts

— Nineteen trusts were rated as excellent for both quality of services and use of resources, compared with just two last year

— Of these, the Royal Marsden NHS Foundation Trust, a dedicated cancer hospital, was the only organisation to achieve top ratings two years running

— Twenty trusts were rated as weak in both categories, four for the second year in a row: Northern Devon Healthcare NHS Trust; Royal Cornwall Hospitals NHS Trust; Surrey and Sussex Healthcare NHS Trust; West Hertfordshire Hospitals NHS Trust

— Full ratings can be found online at www.healthcarecommission.org

Source: Healthcare Commission

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