Dr Morrish said the trust has struggled to meet targets

Senior staff at Bedford Hospitals explain how they met government targets.

Bedford Hospitals NHS Trust was awarded a zero star rating by the Department of Health last year.

Too many of its patients were waiting more than 18 months for an operation.

Too many patients were spending too long on trolleys because of a shortage of beds.

Too many operations were being cancelled and patients with suspected cancer were waiting too long to be seen by a doctor.

The Audit Commission assessed the performance of every trust in England At a glance

The trust's finances were also in a poor state.

Staff have spent the past 11 months trying to tackle all of these issues in an effort to improve the trust's star rating this year.

They are confident their efforts will pay off when ratings are published shortly.

Dr Nick Morrish, a clinical director at the trust, said progress is being made.

"The whole organisation has been under very considerable and sustained pressure to meet the access targets that we have been set.

"We have managed to do it but through considerable re-organisation and creative working."

Team working

Managers gave key staff responsibility for ensuring each of the targets was met.

They also set up teams to work across the hospital to tackle problem areas, such as inpatient and outpatient waits.

"People were working very well in one part of the trust," says Ian Campbell, the trust's deputy chief executive.

By the end of March, we had treated 16% more patients than we had the previous year Ian Campbell, Deputy chief executive

"We got people to work together across the hospital as a group. We set up teams to focus specifically on outpatients, inpatients and emergency care."

The trust also paid consultants and other hospitals to carry out extra operations.

"By the end of March, we had treated 16% more patients than we had the previous year," says Mr Campbell.

"We have also made better use of routine sessions and looked at why operations were cancelled.

"We also organised more evening and weekend sessions and paid other hospitals inside and outside the NHS to carry out operations to help us cut waiting lists."

The Audit Commission has expressed concern about this practise saying some trusts may not be able to sustain it in the long-term.

But Mr Campbell does not believe this will be a problem at Bedford because they have successfully tackled the backlog of patients.

"We have not allowed waiting lists to creep back up," he says.

'Medical priorities distorted'

However, doctors at the hospital believe the focus on targets may have distorted medical priorities, which has meant some patients may have had to wait longer for treatment because doctors were busy trying to meet targets.

"To a degree that has to be true because the targets only focus on certain parts of medical care and there is a general feeling that the specific targets are being prioritised over and above sometimes the clinical needs of other patients," says Dr Morrish.

He said the focus on targets meant staff were not able to work the way they want to.

"In general, doctors and all NHS staff want to give patients the best possible service they can."

He agrees with the Audit Commission's finding that some hospitals may struggle to sustain improvements.

"It is very worrying," he says.

"The pressure we put ourselves under to meet last year's targets has not been fully resourced.

"We are looking at having to make �4.7m cost improvement programmes this year to meet the financial target.

"It is going to be very difficult, challenging, if not impossible to balance the two."

He warns that many of these problems will continue unless the government reduces the number of targets it wants trusts to meet.

"I think no one is against shorter waiting times, quicker operations and less time in casualty.