The Trust responsible for Musgrove Park performed well

But managers at the Bristol Royal Infirmary, the Royal United Hospital (RUH) in Bath, Frenchay Hospital and Southmead Hospital say the figures do not reflect their true performances.

Other hospitals in the region performed better.

Gloucestershire Hospitals NHS Trust, and Cheltenham and Tewkesbury, received the maximum of three stars along with their partnership NHS Trust which looks after mental health.

The chief executive of the NHS is saying Bristol is unique in terms of its management problems Matthew Hill Health correspondent

And the Taunton and Somerset NHS Trust, which runs Musgrove Park, also received the maximum.

Salisbury Health Care and the Swindon and Marlborough NHS Trust both received two stars.

Trusts were assessed on a variety of government targets, from the length of time patients wait for treatment to the number of patients who die after surgery.

The figures were compiled by the independent watchdog, the Commission for Health Improvement (CHI).

The RUH missed four of the nine targets: three focusing on waiting times and one due to its �24m debt.

'Unstinting work'

John Waldron, medical director at the RUH, said: "The real message for patients and staff is that clinically, the standards are high, but that waiting times are too long and the financial situation is difficult, and we have to address this."

Graham Nix, acting chief executive of the United Bristol Healthcare, said he was "disappointed by the ranking".

He said: "Staff have worked unstintingly over the last year to improve the trust's performance.

"I'm disappointed on their behalf that the ratings published do not fully reflect the enormous progress they've made."

And for the first time North Bristol Trust - covering Southmead and Frenchay - was also given no stars.