Older people are the biggest users of healthcare, occupying almost two thirds of our hospital beds. Yet they continue to be a low priority in both the planning and development of our health service.

It is very serious for children because there is growing evidence of early onset diabetes in children who are overweight. Children who are overweight tend to grow into adults who have a range of health problems as well.

Although timely access to GPs and dentists is important, the quality of care that patients receive from their GP, dentist or midwife is also crucial and according to patients, it is extremely good.

Trusts should take note that they will feel the effect in their annual rating if they fail to rise to the challenge.

A&E departments now have to go the extra mile if they are to deliver the care that patients need and that means focusing on quality as well as waiting. This report suggests serious variations in the quality of care. Monitoring standards of quality must become a core part of the day-to-day management of these units.

We expect to see changes as a result of this work and we will be using participation in the audit as part of our annual performance ratings for primary care trusts.