Performance overall is improving

Many hospitals have stayed the same but actually there are more risers than fallers, there are fewer hospitals getting zero stars. Hospitals have raised their game and perfomance overall is improving... people have a right to know how their local health service is doing... the public have paid for it, they use it and have a right to know

A total of 68 of England's 304 trusts received a full three stars in this year's ratings.

Zero star trusts

Bedford NHS Trust Bedfordshire and Luton Community Health Trust Barnet and Chase Farms Hospitals NHS Trust Hinchingbrooke Healthcare NHS Trust Portsmouth Hospitals NHS Trust Royal United Hospital Bath NHS Trust South Warwickshire General Hospitals NHS Trust South Warwickshire Combined Care NHS Trust United Bristol Healthcare Trust Weston Area NHS Trust

10 trusts received no stars at all and standards were found to have fallen in 36 trusts.

The hotel-style grades will be used by ministers to decide which hospitals should be given more freedom from government control and which should be 'franchised out' to new management teams.

Overall, 46 acute trusts were awarded three stars, 77 got two stars and 35 received one star.

Eight acute trusts were given a zero rating, including three trusts who had come bottom of the league last year. Two of these had also been 'franchised out' to new management in an effort to improve services.

The tables show that standards improved in 47 trusts compared with last year but deteriorated in 36.

The tables also give details of the performance of specialist trusts, which include specialist eye or children's hospitals.

Of these, six received three stars, 12 two stars and two one star.

Ambulance ratings

The Department of Health also assessed ambulance trusts - 12 were awarded three stars, 16 won two stars and four got one star.

Mental health and community trusts were included in this year's tables for the first time.

Of these, four were awarded three stars, 67 were given two stars, 13 received one star and two were given a zero rating.

The new primary care trusts were also examined. However, they were not given star ratings since many have only been in operation since April.

All trusts were assessed on a variety of targets, including patient waiting times, deaths after surgery, cleanliness and finances.

The best-performing trusts were Birmingham's Good Hope NHS Trust and Surrey's Epsom and St Helier Trust.

Both received a zero-star rating last year but have now been awarded two stars after improvements in recent months.

Among the losers were Bedford NHS Trust in Hertfordshire and Hinchingbrooke NHS Trust in Huntingdonshire.

Both received two stars last year but have dropped to the bottom of the league table this year.

Managers at many of the zero-rated trusts criticised their ranking saying they were based on old data and did not reflect recent progress.

Ministers have already announced that trusts with three stars will be able to apply for foundation status. If successful, they will be given more freedom within the NHS to set their own targets and priorities.

The three star trusts will also receive up to �1m this year to improve patient services.

Franchised out

In contrast, 'failing' trusts are to be ordered to draw up urgent plans to improve their services.

Most of the trusts which received no stars will have just three months to show signs of improvement or face being franchised out to a new team of managers from elsewhere in the NHS, or the private or independent sectors.

Trusts where managers have already been replaced or franchised out will be given 12 months to turn their services around.

This year's ratings may damage morale among nurses

Beverly Malone, RCN

However, the Conservatives said the tables showed that the government's policies on the NHS were failing.

Shadow Health Secretary Dr Liam Fox said: "The fact that 36 acute trusts have actually deteriorated since the last assessment is proof - though none were needed - that Labour's approach of simply throwing money at the system is not the answer."

He added: "The whole star rating process is completely flawed. Any objective analysis would show that it is nothing more than a rag-bag of management targets which have little to do with quality of care."

Liberal Democrat health spokesman Dr Evan Harris said: "This is a disgraceful exercise in scapegoating. Meaningless measures imposed by politicians end up being fiddled by pressurised trusts."

Staff criticism

Doctors, nurses and hospital managers have also criticised the ratings.

Dr Peter Hawker, chairman of the British Medical Association's consultants committee, said they created "a pressure cooker atmosphere" in hospitals.

He added: "Consultants share the government's desire to improve services for patients and speed up access, but the flood of new targets, initiatives and performance measures is destabilising the NHS."

Beverly Malone, general secretary of the Royal College of Nursing, warned that the ratings could do more damage than good.

"This year's ratings may damage morale among nurses, many of whom are doing a good job under excessive pressure," she said.

The NHS Confederation, which represents health service managers, also criticised the ratings.

Gill Morgan, its chief executive, said "more robust and reliable" data is needed if an accurate of the NHS is to be provided.

Stuart Marples, chief executive of the Institute of Healthcare Management, added: "We still have severe reservations about damning whole multi-million pound organisations from a snap shot of indicators."