THE NHS Trust which provides services for mentally ill people Buckinghamshire Mental Health Trust has been given no stars for the third year in a row. But chief executive Julie Waldron says things have improved during the current year and that the trust provides good patient care.

The trust was set up four years ago by amalgamating services provided by several other NHS bodies. Since then it has had problems balancing the books and getting the staff it needs.

The annual star ratings for NHS trusts, which measure performance in key areas, are decided by the Healthcare Commission. Those for 2004/5 were announced last week .

Top rating is three stars; bottom rating, zero.

The six NHS trusts in Buckinghamshire are the mental health trust; Buckinghamshire Hospitals' Trust, which runs Wycombe, Stoke Mandeville and Amersham hospitals; Two Shires Ambulance Trust, which serves Buckinghamshire and Northamptonshire; and three Primary Care Trusts (PCTs) which buy health care.

They are marked on factors such as waiting times, cleanliness, food, cancer treatment, smoking cessation, access to GPs, drug treatment, immunisation rates. Financial management is all important.

Both Chiltern and South Bucks and Wycombe PCTs kept their three-star rating, though Vale of Aylesbury PCT dropped from three to one. There are 303 PCTs in the country and 58 received three stars.

The ambulance service kept its three stars and Bucks Hospitals' Trust went up from one to two.

At Chiltern South Bucks PCT, chief executive Bart Johnson said efforts to improve health as well as treat sickness was reflected in the PCT achieving maximum scores in that category.

Wycombe PCT met all key targets; teenage pregnancies were reduced. Flu vaccinations and access to eyesight screening for diabetic patients met.

Only 37 per cent of people had access to a NHS dentist but a new practice in Loudwater would take on NHS patients, said the trust.

Chief executive Paul Bennett said: "Commitment to patients will not waver."

Buckinghamshire Hospitals' Trust has achieved all key targets. No one had to wait more than 12 hours to be admitted to hospital through A and E; 98 per cent of suspected cancer patients were seen within two weeks; outpatients appointment times and routine operation waiting times were met.

The number of cancelled operations, quality of hospital food and number of patient complaints scored three out five.

Zero stars means there are significant areas of weakness in a trust. One of these at Buckinghamshire Mental Health Trust is finance.

But chief executive Julie Waldron said although the trust had agreed a package with the Strategic Health Authority to break even over two years, the Health Commission did not recognise this.

She said spending was high for two reasons.The trust had inherited a lot of expensive to run premises and rationalising this took time. And medical vacancies meant employing agency staff, which were three or four times as expensive. "We have spent £1million more than we have in our budget on this a huge amount of money for a small organisation."

Lack of financial monitoring, poor food and lack of cleanliness were all being tackled, she said.

"We knew we had to improve and the trust has improved. We provide a good standard of care and we have good staff working hard."