Almost a third of National Health Service hospitals risk being refused a licence to operate because they are still not meeting core standards of safety, effectiveness cleanliness and record keeping, the Healthcare Commission, the NHS inspectorate, warned on Thursday.

The failure to fully cover the basics comes despite a big improvement in the health service’s performance over the past three years, the commission said in its annual “state of the nation” report on the NHS. From April 2010, NHS hospitals and organisations will go through a registration system that will issue them with a licence to operate.