Organisations and campaigners give their reactions.

Patients have reason to worry at the outcome of the Healthcare Commission's annual health check, with the quality of services in six out of 10 trusts showing up as fair or weak. A poor result for all the money that has been thrown at the NHS over the past few years.

The new checking system relies heavily on self-assessment by trusts, as they declare that they have met a set of core standards.

The commission made random inspections at some 12% of trusts and in these over four out of 10 had overrated their compliance with the standards and received penalty points.

This leads us to suspect that the overall standard is actually even lower than the assessment figures suggest.

The post code lottery that bedevils the NHS is pointed up sharply. Worst off are patients in the south-west, with the south coast (where a large proportion of patients are elderly) faring little better, while in the Midlands patients do pretty well. Best served are those in the north.

It is particularly disappointing to see that half of all trusts have not reached their targets for reducing MRSA.

For most patients the first question when choosing a hospital is 'what are the infection rates like?'.

We welcome the publication of the annual health check results and support the new way of measuring NHS services as a positive step forward.

However, it is important to remember that because this is a new, more comprehensive way of measuring trusts it is not comparable to the star ratings that went before it.

The health check is measured against a much tougher and demanding set of standards and targets than the star ratings and this move to a broader system is bound to uncover areas that need further improvement.

All trusts will now be able to focus on areas needing improvement and will be working hard to improve standards of care.

The spread of results across different types of NHS organisations is proof that the latest round of reorganisations has adversely affected services.

Foundation trusts, who haven't been reorganised and have extra freedoms to manage their own affairs, have been able to get on with the job and improve services as the health check shows.

The health check results also reveal the importance of investing in the development of commissioning across the country.

When looking at these results it is important to remember that fair does not mean 'failing' and weak does not imply 'unsafe'. Also, the new approach is designed to incentivise honesty and transparency, so that trusts can take firm action where there is a problem.

The old star ratings were an inadequate and crude system of measurement and we welcome the annual health check as it provides a much better analysis of trusts' performance across the board.

The results paint a mixed picture, and although some of the information is worrying, much of it confirms what we already knew.

On the positive side, the NHS continues to do well on key targets around waiting times, cancer and some public health areas.

However, it is unacceptable that quality of services and resource management remain weak in so many trusts.

There is clearly a mountain to climb here especially in financial management - in part a legacy of the health service not grappling with underlying deficits early enough.

This is year zero for the NHS. Ultimately what will matter is whether trusts are able to improve their quality of services and use of resources year-on-year.

It is clear that healthcare professionals have worked hard to deliver good standards of care and this is evident from the number of trusts achieving positive ratings for quality and patient experience.

This is despite the incoherence of government policy frequently getting in the way of staff being able to deliver high quality care for their patients.

Patients will benefit from having better information about their hospitals and primary care trusts.

However, the new assessment procedure does not yet fully reflect the standard of clinical care or the success of treatments or operations.

Further work will need to be undertaken to find ways of providing patients with accurate and meaningful information on detailed aspects of the clinical care they need.

It is not surprising that PCTs have been shown as the worst performers when they have been subjected to constant reorganisation and restructuring.

The NHS needs a period of stability to deliver the necessary improvements in care for patients. It is a significant concern that a number of trusts are weak on both quality and the use of resources.

We feel this is usually because there is a lack of engagement with clinicians in the management of the organisation.

It is vital that trusts are now supported to adopt a collaborative approach, between managers, clinicians and patients, to generate long term solutions."

The Healthcare Commission report paints a picture of our health service stripped of any spin.

We will have to wait until next year, when hopefully the dust will have settled on some of the many reforms taking place, before we can truly judge what progress has been made.

On the face of it, this report paints a very mixed picture, with room for improvement in a number of areas.

There is some good news for patients, with the quality of service in 54% of acute and specialist trusts rated good or excellent.

It has been a difficult year for staff, with trusts struggling to cope with debts and the threat of redundancy looming in many areas.

Staff should be congratulated for the overall quality of patient care and for the considerable progress on targets for screening services, waiting times for cancer services and in A&E departments.

In a significant number of hospitals the quality of care has been reduced because of poor cleaning standards and the persistent problem of hospital acquired infections.

Patients want clean wards and hospitals and we need to employ more cleaners to raise the standard of hygiene.

Primary care trusts are struggling under the weight of the massive reorganisations taking place in the service.

They are under considerable pressure because of the introduction of the private sector into primary care services.

Independent Sector Treatment Centres are proving a costly drain on their resources and this expenditure is proving difficult to control.

The Healthcare Commission claims that inspections have 'shone a bright light' on the declarations made by trusts but these inspections only scratch the surface.

Instead of relying on inspectors they should turn to patients, who are best placed to shed light on how they are treated.

The performance assessment ratings largely bypass patients' views and are the equivalent of asking students to mark their own exam papers.

They are based on the findings of self-assessments - which reflect what hospital managers think of themselves rather than the experiences of patients.

The Healthcare Commission needs to review the assessment process if we are going to achieve a truly patient-led NHS.