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The Care Quality Commission today (Thursday) published performance ratings for all 392 NHS trusts in England.

CQC said the NHS is performing well against a rigorous assessment on quality, with more trusts rated “excellent” or “good”.

It also commended the significant improvement in ratings for financial management, which is good news coming into a period of restraint on public spending.
 
The assessment shows big improvements for patients with more people seen in A&E within four hours, more receiving treatment within 18 weeks of referral, more screened for chlamydia and big reductions in MRSA & Clostridium difficile cases.

But CQC raised concerns about the 20 trusts rated “weak” this year on Quality and a further 27 that have not been higher than “fair” for Quality and Financial Management in the last four years.

These organisations face a tough challenge to meet requirements of the new registration system, which CQC will introduce next year.

Thirty-seven trusts were rated double-excellent, including The Royal Marsden NHS Foundation Trust, which was double-excellent for the fourth year running.

Barking, Havering and Redbridge University Hospitals NHS Trust was the only trust rated double-weak, down from six trusts last year.

CQC ascribes ratings to trusts based on their performance across a range of priority areas identified by the government.

For Quality, CQC rated 15% of trusts “excellent”, 47% “good”, 33% “fair” and 5% “weak”. Last year, ratings were 26%, 35%, 34% and 6% respectively.

On Financial Management, 26% were rated “excellent”, 45% “good”, 26% “fair” and 3% “weak”. Last year, ratings were 24%, 37%, 34% and 5% respectively.

Primary care trusts earned better results overall, with more than half rated "excellent" or "good" for the first time.
 
But there was a decrease in ratings awarded to acute hospital trusts, with fewer trusts rated "excellent" and more "fair".

CQC said a number of factors were behind the acute trust ratings: more trusts declared they did not meet all core standards; increased scrutiny on child safeguarding and healthcare-associated infection; a significant number did not meet new indicators on quality of basic maternity data and participation in heart disease audits, vital to monitor quality of care; a significant number did not meet required performance on specialist stroke care; and a greater proportion of operations were cancelled at the last minute for non-clinical reasons.
 
CQC also pointed out that this year it has produced the most comprehensive and rigorous assessment ever of the performance of mental health and ambulance trusts.

For example, the assessment has looked at how ambulance crews treat heart attack patients, as well as how quickly they arrive on the scene.  And, for the first time, it has looked at care provided by mental health trusts for people with learning disabilities.

Positive improvements for patients include:

• More than 98% of the 19 million patients attending A&E waited less than four hours
• Between January and March this year, three million patients waited 18 weeks or less from referral to treatment
• 16% of people aged 15 to 24 were screened for chlamydia, up from 5% the previous year
• There were 19,400 fewer cases of Clostridium difficile and 1,500 fewer cases of MRSA in 2008/09 compared to 2007/08 – a reduction of a third for both
• Ambulances responded within eight minutes to more than 1.4 million life-threatening calls (category A)
  

However, the assessment highlights the following issues:

• There was a drop in compliance with the core standard on child safeguarding down from 96.4% last year to 90.7% this year.
• While MRSA and C. difficile rates are decreasing, acute trusts still need to do more on infection control. This year 48 acute trusts did not meet at least one of the three relevant standards, compared to 44 last year.
• 37% of acute trusts meet the required level of performance on specialist stroke care
• New measures highlight considerable variation in quality of basic maternity and mental health data that is vital for monitoring quality of care.
• The proportion of cancelled operations rose for the second year in a row to almost one per cent. This equates to 63,000 operations cancelled at the last minute for non-clinical reasons. However, of these cancellations, more were rearranged for a new date within 28 days of the original operation.
  

Today’s assessment measures performance in the NHS in key priority areas set by government. Next year, CQC will further develop regulation to become more focussed on patients and outcomes. All trusts will need to register with the regulator to legally function.

CQC said compliance with core standards is a good indication of whether a trust is ready for registration. Overall compliance with standards has increased from 95% to 96%. However, only about half of trusts fully met all core standards and compliance declined in the acute sector with 59% fully met this year compared to 69% last year.

Cynthia Bower, CQC chief executive, said: “The NHS has performed well on quality, which is good news in the face of a rigorous assessment. Those rated ‘excellent’ deserve to be commended – it is not easy to achieve this rating and missing just one standard could drop the score. Trusts rated ‘good’ have also performed strongly.

“But it is clear that some trusts are struggling and that some issues are proving tough nuts to crack. My biggest concern is those trusts that are ‘weak’ and persistently ‘weak’ or ‘fair’. They must do better for their patients.

“I want to ring the alarm bell in the boardrooms of these organisations. Next year, all trusts must register with us to legally function. It is clear that many have significant work to do and a short time in which to do it.”

CQC is committed to making sure that services involve people and respond to their views.  As part of this, it is today urging people to comment online about the NHS and their local services.

Details of the performance ratings for individual trusts are available on the CQC website. From Thursday 15 October, go to "Find care services" at www.cqc.org.uk and enter your postcode to find your local trust.  From here, people can link to the NHS Choices website to have their say. Comments can be posted anonymously and are fed through to the hospitals and trusts concerned, giving them the opportunity to respond online if they wish. They will also be used by CQC to monitor NHS performance.

Results for Quality by trust type

Acute and specialist trusts: 22% are “excellent”, 48% “good”, 25% “fair” and 5% “weak”, compared to 31%, 46%, 18% and 5% respectively in 2007/08. Reasons for this decline in ratings is detailed on page one of this press release.

Primary care trusts: CQC rated 2% of PCTs “excellent”, 51% “good”, 45% “fair” and 3% “weak”, compared to 6%, 27%, 62% and 5% respectively in 2007/08. The improvement is driven by greater compliance with core standards and improved performance against some measurements, including that related to chlamydia screening. However, 22% of PCTs achieved their local plans to reduce the rates of teenage conception.

Mental health trusts: In 2008/09, 30% scored “excellent”, 46% “good”, 16% “fair” and 9% “weak”. Last year, the ratings were 64%, 25%, 7% and 4% respectively in 2007/08. Trusts are now assessed against eight new indicators. Trusts struggled to meet a new indicator relating to quality of basic data which is essential to monitor quality of care.

Ambulance trusts: No ambulance trusts scored “excellent”, two scored “good”, six “fair” and three “weak”. Last year, two were “excellent”, five “good”, one “fair” and three were “weak”. There are seven new indicators in the assessment. Nationally, the number of life threatening calls (category A) responded to within eight minutes dropped from 77% last year to 74.3% this year. However, this still represents a strong performance given a continued increase in calls and the eight minute clock starting earlier.

Core standards with highest rate of compliance

• C08a (100% compliance) – support for staff to raise concerns about services
• C10b (100%) – professionals abide by relevant codes of professional practice
• C14a (99.8%) – providing information about how to complain
• C22a&c (99.8%) – organisations cooperate to improve health of the community
• C06 (99.6%) – health and social care organisations cooperate
• C07b (99.6%) – promote openness, honesty, probity, and accountability
  

Core standards with lowest rate of compliance

• C11b (87.6%) – participation in mandatory training
• C09 (88.3%) – systematic and planned approach to records management
• C04c (88.3%) – reusable medical devices are properly decontaminated
• C04b (89.6%) – minimise risks of medical devices
• C07e (90.5%) –   challenge discrimination, promote equality and respect human rights
• C02 (90.7%) – protect children by following national child protection guidelines
  

More information about the performance ratings