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BMJ. 2007 October 27; 335(7625): 849.
PMCID: PMC2043422

More than half of NHS trusts need to perform better, says report

The Healthcare Commission, the independent NHS watchdog, has delivered its annual “health check,” which shows an increase in the number of trusts in England providing good or excellent services. However, the performance of more than half of NHS trusts is still either fair or weak.

As this is the second year of the health check, the report provides the first opportunity to compare NHS performance with the results for 2005-6. All 394 trusts are scored in two main categories: quality of services and financial management. The commission was “concerned” that 20 trusts (5% of the total) were ranked weak in both categories.

On quality of services (such as meeting waiting list targets) 16% of trusts were judged excellent and 30% good, an improvement on the previous year. At the lower end of the scale, 45% were fair and 8% were weak. On use of resources trusts faired less well, although an overall rise in standards was shown—37% of trusts were either excellent or good (compared with 16% last year), 36% were fair, and 26% were weak.

Worryingly, says the report, 44 trusts hadn't complied with at least one hygiene standard (see News doi: 10.1136/bmj.39377.429178.13). Hygiene is currently an intensely political issue in the United Kingdom since the recent deaths of 90 patients in outbreaks of Clostridium difficile in the hospitals of a trust in Kent (BMJ 2007;335:790, 20 Oct doi: 10.1136/bmj.39367.650266.DB).

Anna Walker, the Healthcare Commission's chief executive, said, “This has been a tough year for the NHS, with significant reorganisations taking place and tougher standards on infection control. Many trusts have stepped up to the challenge.”

Four trusts were named as the worst performers: Northern Devon Healthcare NHS Trust, Royal Cornwall Hospitals NHS Trust, Surrey and Sussex Healthcare NHS Trust, and West Hertfordshire Hospitals NHS Trust.

Health secretary Alan Johnson warned that managers from these trusts would now meet the NHS chief executive, David Nicholson, for urgent talks to assess how they plan to “remedy the situation.” Mr Johnson said that in the worse case scenario trusts might be taken over by well performing trusts. “We will consider radical action,” he said.

The BMA's chairman, Hamish Meldrum, said it was good to see that so many NHS trusts in England had shown an improvement in the quality of services and use of resources.

“However, we remain concerned that a number of trusts are continuing to underperform. This is very disappointing news, and it is vital, for the sake of patients, that these underperformance issues are urgently addressed,” he said.

On the issue of hygiene Dr Meldrum warned the government not just to point the finger of blame at staff.

He said, “All staff working in the health service have a role to play in controlling infection. Only a coordinated approach addressing all the relevant factors, for example high rates of bed occupancy, inadequate staffing levels, effective cleaning regimes and isolation policies, is likely to be successful. A culture of fear, where chasing targets and saving money seem to be paramount, will not help managers and healthcare professionals deliver effective infection control.”

The report also shows that most patients in England who need hospital treatment were not being offered a choice of treatment centres by their referring GPs, despite this being promised to patients.

As many as 70% of trusts failed to meet this target—the worst area of performance in any of the existing national targets. GPs are not contractually obliged to offer such a choice through the “Choose and Book” system, the report says, and the necessary computer systems have had technical problems.

Dr Meldrum said this was no surprise. “There is a lot of evidence that imposed referral management schemes and problems with the Choose and Book IT system have worked against patient choice. The BMA has urged the government time and time again to work with doctors before rolling out expensive software systems, but unfortunately this has not happened.”

Further reading

Results from the Healthcare Commission's 2006-7 annual health check are at .http://2007ratings.healthcarecommission.org.uk


Articles from The BMJ are provided here courtesy of BMJ Group