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Health services in part of Kent have been graded as among the poorest in the country.
In the latest health check ratings, published by the Healthcare Commission, Maidstone and Tunbridge Wells NHS Trust and NHS West Kent were graded as 'weak' for the quality of their services.
Last October NHS West Kent, which was then known as West Kent Primary Care Trust, was rated as 'fair' for its quality of services.
However, there was better news elsewhere in the county as the Dartford and Gravesham NHS Trust was given an 'excellent' rating - up from 'good' last October and 'fair' in October 2006.
The Healthcare Commission ratings cover the period April 2007 to March 2008.
This included the publication of a critical report into superbug infections at the Maidstone and Tunbridge Wells NHS Trust.
Hospitals were graded on issues including safety and cleanliness, standards of care and how long patients waited to be seen.
The hospital trust’s chairman, George Jenkins, said the trust was very critical in the assessment it gave to the Healthcare Commission.
He said: "We took nothing for granted and if we couldn’t justify areas of good performance for all our patients last year we rated ourselves down."
It has since recruited 100 extra nursing staff and now has the lowest rates of C-diff in the south east.
Steve Phoenix, chief executive of NHS West Kent, said: "We are disappointed - but our services are absolutely safe and efficient. We had already identified the areas flagged up in this report and have taken action."
Medway NHS Foundation Trust, Medway PCT, East Kent Hospitals Trust and the Eastern and Coastal Kent PCT were all rated as 'fair'.
South East Coast Ambulance Service was rated 'good' and the Kent and Medway NHS Social Care Patnership was graded 'fair'.
Candy Morris, chief executive of NHS South East Coast, said: "While Kent has areas of absolutely stunning clinical performance we also know there will be areas that doctors and patients say need improving.
"Many hospitals fell down on the 18-week target between a GP referral and a hospital appointment. NHS South East Coast will also provide support and advice to those trusts graded weak."
Nationally for quality of services, 100 trusts (26 per cent) were 'excellent'; 139 (36 per cent) were 'good'; 132 (34 per cent) were 'fair'; and 20 (five per cent) were 'weak'.