One in eight NHS trusts has been told it must urgently improve the care it provides, by a new regulator publishing ratings on England's 392 trusts.
The assessments by the Care Quality Commission show a drop in the number of hospitals meeting basic standards in areas such as hygiene and safety.
But it also said more services than ever could be rated good or excellent.
From April, the CQC will gain new powers to be able to shut any of the 47 underachieving trusts down.
The new commission, which took over the watchdog duties of the old Healthcare Commission earlier this year, pointed out a number of successes in its report.
These included what it called the notable achievement of most patients in England receiving hospital treatment within 18 weeks.
The government said this was the most rigorous assessment the NHS had ever seen.
NHS Ratings Health Minister Mike O'Brien said the report showed improving standards across the health service.
"We have transformed the waiting experience for millions of patients and now have the shortest waits on record. MRSA and C. difficile infections have been significantly reduced and over three quarters of GP surgeries are providing extended opening hours, giving patients greater choice and more convenient access to GPs."
But shadow health secretary Andrew Lansley said the report showed the government was unable to "turn round poor performers".
"Many staff are doing a great job in keeping up high standards but we cannot allow that to obscure the fact that there has been poor performance in some very important areas in the NHS, such as maternity and stroke services.
"And it is unacceptable that the number of patients who have had their operations cancelled has risen so sharply."
The CQC looked at every type of NHS trusts, including acute, mental health, primary care and ambulance.
Barbara Young, Care Quality Commission, on nipping poor performance in the bud
More than half of primary care trusts were rated good or excellent, with many patients reporting being able to get an appointment within two days and services such as chlamydia screening for young people improving.
There were, however, significant regional variations, with trusts in London performing particularly poorly on patient satisfaction with appointments and opening times.
Fewer mental health trusts were rated excellent or good, and some struggled to meet new criteria on collecting data about services. Ambulance services also failed to perform as well as last year, but the CQC nonetheless praised the general response to emergency calls.
But much of the focus is on hospitals: fewer acute and specialist trusts were rated excellent, with more receiving an unimpressive fair grading.
Based on a system of self-reporting, there was a significant drop in the number of acute trusts fully meeting basic standards such as those relating to hygiene, child protection and training: this was down to 59% of all trusts from 69% last year.
Many also failed to meet new performance targets, such as the collection of maternity data to help improve services, and stroke care.
The number of operations cancelled rose for the second year in a row - equating to 63,000 procedures called off at the last minute for non-clinical reasons.
PARTICULARLY POOR PERFORMERS
Royal Cornwall Hospitals NHS Trust
Great Western Ambulance Service NHS Trust
Yorkshire Ambulance Service NHS Trust
Maidstone and Tunbridge Wells NHS Trust
Barking, Havering and Redbridge Hospitals NHS Trust
However a higher proportion are now being rearranged within 28 days of the original appointment, and the figure also reflects the much higher number of people now receiving treatment.
Waiting times for treatment have fallen to 18 weeks or less this year, one of the achievements highlighted by the regulator.
It also noted that 98% of the 19 million patients who attended A&E waited less than four hours, while rates of the infections Clostridium difficile and MRSA had both fallen by about a third - despite hospitals themselves reporting failings in hygeine.
While a number of trusts were singled out for praise - including the Royal Marsden, which has scored excellent every year for both quality and finance - the CQC said the focus now had to be on those which had performed persistently poorly.
Twenty trusts scored weak for overall quality, while 27 others have now never scored higher than fair for either quality or finance in the four years since the ratings system was started.
Some particularly poor performing acute trusts were highlighted: Barking, Havering and Redbridge hospitals received a double weak rating, while the Royal Cornwall Hospitals NHS Trust was deemed weak for the fourth year in a row.
Maidstone and Tunbridge Wells NHS Trust - which saw a deadly outbreak of clostridium difficile amid serious hygiene lapses between 2004 and 2006 - was rated weak for the third year in a row.
The CQC said it intended to work closely with these 47 trusts to sort out their problems ahead of April next year, when it will gain the power to intervene in every trust, from dealing out admonishments to potentially launching prosecutions and closing services down.
"But that would be the extreme nuclear option for any regulator," said CQC head Cynthia Bower.
"Trust are aware of what their issues are, so none of this is going to come as a surprise to them.
"There is an ongoing process of debate to sort these problems out by April, no-one is just waiting around."
The King's Fund chief executive Niall Dickson stressed that overall the report showed the NHS appeared to be performing well, but that it was unfortunate the ratings did not shed light on why some did well and some badly.
"Patients served by the hospitals and other services that consistently rank at the bottom have a right to know why these organisations are not providing the quality of services that is expected from them.
"We need to understand whether the problems are managerial or structural, and what is being done to help them raise their game."
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