Hospitals in Sussex were today branded the poorest performing in England.

Brighton and Sussex University Hospitals NHS Trust has been given no stars in the annual performance ratings published by the Healthcare Commission.

The trust runs the Royal Sussex County, Royal Alexandra and Sussex Eye hospitals in Brighton and the Princess Royal Hospital and Hurstwood Park neurological unit in Haywards Heath.

Surrey and Sussex Healthcare, which runs Crawley Hospital, has also been given the lowest possible rating.

The two trusts are among only ten in the country to be given no stars out of a possible three and are now classed as failing.

The zero status means they have shown the poorest level of performance against key targets set by the Government to improve treatment and care of patients and hospital management.

Last year both trusts were given a single-star rating, which meant their performance was already showing some cause for concern.

The ratings system, widely criticised for providing too simplistic an assessment of NHS trusts' performance, is based on a series of targets and performance indicators. These include four-hour maximum waits in accident and emergency (A&E), hospital cleanliness, waiting times for surgery and financial management.

The ratings also assess how trusts are tackling hospital-acquired infections such as MRSA but do not take into account the actual rates of infection.

East Sussex Hospitals, responsible for the Eastbourne District General, which had two stars last year, has dropped to one star.

There was better news for Worthing and Southlands Hospitals, which improved from one star to two.

This means it is performing well overall but has not quite reached consistently high standards.

The Royal West Sussex, which runs St Richard's Hospital in Chichester, has kept its two-star rating from last year.

The best performer is once again the specialist Queen Victoria Hospital in East Grinstead.

It was given the maximum three stars, meaning it has the highest levels of performance.

Sussex Ambulance Service has managed to keep its single-star status despite missing the crucial target of answering all Category A emergency calls within eight minutes.

Mental health and community trusts have shown a mixed performance.

East Sussex County Healthcare dropped from one star to no stars, South Downs Health stayed at two stars and West Sussex Health and Social Care improved from one to two.

Most primary care trusts in Sussex, including Brighton and Hove City, were given a two-star rating but Mid Sussex made a significant improvement, leapfrogging from one star to three.

The poorest performer was Eastbourne Downs, which dropped from two stars to one.

Brighton and Sussex significantly failed in two key areas - financial performance and bookings for operations.

The trust is trying to overturn an £8 million deficit caused mainly by the amount it has spent on agency nurses to cover staff shortages.

It also struggled to meet the target for A&E, where 90 per cent of patients need to pass through the department within four hours.