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STANDARDS at London's hospitals are condemned in a report today from the healthcare watchdog.

It reveals a picture of crippling debts, missed targets and slow improvements in public health.

The Healthcare Commission's annual NHS performance tables are based on a star-rating system for hospitals, ambulance services, mental health trusts and primary care trusts (PCTs), with zero for those at the bottom and three stars for those at the top.

The commission found that in London:

* Twelve hospital trusts dropped at least one star and three dropped two.

Only six out of 32 improved on last year.

* Nine hospital trusts managed three stars, including University College London Foundation Trust, which was given top marks across the board.

* No primary care trust received three stars and nine were rated worse than a year ago but four jumped from zero to two stars, including Tower Hamlets;

* Hillingdon trust received no stars due to high rates of smoking in the population, poor financial management and long waiting times in accident and emergency.

Anna Walker, the commission's chief executive, said the NHS nationally was performing better against tougher targets but it faced a deficit of [pounds sterling]500million.

"The fly in the ointment has been financial management," she said. "A quarter of all trusts and one-third of acute hospital trusts have failed to achieve the key financial target. We consider this a serious issue which does need to be addressed because patient care will suffer if financial management isn't got right by the trusts."

She said the number of hospital trusts with three stars had dropped for the first time in three years, a reflection of poor financial management since more money was being pumped into the NHS, and failure to hit tougher targets for A&E.

Hospitals now have to ensure that 98 per cent of patients in casualty are seen, treated and discharged or sent to a ward within four hours. Many met a 90 per cent target last year but have struggled to improve this year.

The Royal Free Hospital in Hampstead dropped from two stars to zero, partly due to a debt of [pounds sterling]10.2 million.

Chief executive Andrew Way said: "We are currently meeting all the relevant targets and if we were assessed today we believe we would still have two stars. The three key areas where we fell down were finance, the four-hour A&E target and the state of repair of two of the lavatories across our three hospitals."

Ms Walker said PCTs in London were of particular concern as none had managed three stars.

But Dr Gill Morgan, chief executive of the NHS Confederation, which represents NHS organisations, said: "London primary care trusts tackle factors that make the capital different from everywhere else, including a highly mobile population and high levels of HIV, TB, mental illness and sexually transmitted infections.

"The combination of high health need and high costs with extremes of wealth and poverty have an impact on the delivery of healthcare and so low ratings do not reflect all the hard work that NHS staff are doing in challenging circumstances."

The stars system showed that 296 trusts nationally stayed at the same level as last year, 153 improved and 141 got worse.

Four hospital trusts - Brighton and Sussex University Hospitals, Surrey and Sussex Healthcare, Weston Area Health and Mid-Yorkshire Hospitals - failed to improve on their zero-star ratings.

The London Ambulance Service retained its two stars and most mental health trusts in the capital achieved two or three stars.


Verdict on hospitals

* Debts, waiting lists and overstretched accident and emergency departments are the biggest problems for hospitals in London. …


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