Bolton was the only NHS Trust in the north west to get a one star rating with most hospitals gaining a two star, with Blackburn, Hyndburn and the Ribble Valley Trust getting three stars.
It is the first year that the government have assessed hospitals on the star rating system.
Successful trusts and hospitals will be allowed to invest in the private sector and will be given a free financial reign.
Poor trusts will be carefully monitored.
The rating was achieved following nine set criteria examining waiting list targets, cleanliness, last-minute cancellations of operations, length of trolley waits, staff vacancies, breast cancer consultant waits and other clinical factors such as emergency admission death rates.
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