More than half of NHS trusts need to improve their services and the way they manage their finances, according to a report.
The Healthcare Commission's Annual Health Check ranked 570 trusts in England as weak or fair.
It ranked 51% (290) of trusts fair on quality of services; 47% (270) fair on use of financial resources; 9% (50) weak on quality of services and 37% (210) weak on use of financial resources. Overall, 24 were labelled weak for both quality of services and use of resources.
The report examined primary care trusts (PCTs), acute hospital trusts, mental health trusts and ambulance trusts.
It showed that 36% of trusts were rated good on quality of services while 4% were excellent. Just 3% of trusts were found to be excellent at managing their finances while 12% were good.
Just two trusts ranked excellent in both areas - the Royal Marsden NHS Foundation Trust in London, which is a specialist cancer trust, and Harrogate and District NHS Foundation Trust.
Healthcare Commission chief executive Anna Walker said the review showed plenty of examples of good performance. But she added: "However, the NHS does need to raise its game to ensure a universal guarantee that general standards on both quality of services and use of resources are being met."
She stressed that a score of "fair" did not mean a trust was performing unacceptably but did mean there was "room for improvement", adding: "What this assessment is about is systematically looking at each of these trusts to see how they are performing.
"What we are saying about the weak ones is not that they are unsafe but that they do have issues that they need to address quickly."
But she said the report painted a "worrying picture" that showed where NHS financial management was not good enough.
