- Major reform milestone as NHS league tables published across England to raise standards and ensure better value for patients and taxpayers
- Top-performing trusts will be rewarded with greater freedoms and investment, while underperforming trusts to receive targeted support
- Part of the government’s Plan for Change to ensure NHS investment delivers meaningful outcomes, greater efficiency, and real value for patients
Patients will get better care and value from record investment in the NHS thanks to a pioneering new system of league tables being rolled out across England today.
Every trust in England will be ranked quarterly against clear, consistent standards – from urgent and emergency care to elective operations and mental health services.
This marks a new era of transparency and accountability in the NHS, with league tables delivering on the government’s promise to drive up standards, tackle variation in care, and ensure people get the high-quality service they rightly expect.
This is not just about data, it’s about delivery. The public expect results from the record funding going into the NHS, and this reform ensures that investment is matched by improvement. That is why top-performing trusts will be rewarded with greater autonomy, including the ability to reinvest surplus budgets into frontline improvements such as new diagnostic equipment and hospital upgrades.
From next year, a new wave of Foundation Trusts will be introduced, giving the best-performing trusts more freedom to shape services around local needs – a key pillar of the government’s 10 Year Health Plan. Meanwhile, trusts facing the greatest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-linked pay. The best NHS leaders will be offered higher pay to take on the toughest jobs, sending them into challenged services and turning them around.
This will help end the postcode lottery in care, ensuring patients receive timely, high-quality treatment wherever they live. Patient feedback will also play a central role in how trusts are ranked, giving people a stronger voice in shaping their care.
It is part of a series of bold reforms to make the NHS fit for the future by increasing transparency and delivering better outcomes for patients.
Health and Social Care Secretary Wes Streeting said:
We must be honest about the state of the NHS to fix it. Patients and taxpayers have to know how their local NHS services are doing compared to the rest of the country.
These league tables will identify where urgent support is needed and allow high-performing areas to share best practises with others, taking the best of the NHS to the rest of the NHS.
Patients know when local services aren’t up to scratch and they want to see an end to the postcode lottery – that’s what this government is doing. We’re combining the extra £26 billion investment each year with tough reforms to get value for money, with every pound helping to cut waiting times for patients.
Sir Jim Mackey, Chief Executive of NHS England, said:
NHS staff across the country work flat out to deliver the highest standard of care to their patients and every day we see or hear fantastic examples of this, but we still have far too much unwarranted local variation in performance.
Letting patients and the public access more data will help to drive improvement even faster by supporting them to identify where they should demand even better from their NHS and by putting more power their hands to make informed decisions on their choice of provider.
The data also supports local NHS Trust Boards and leadership teams to more easily identify the highest performing services in the NHS and adapt how they deliver care to drive improvement even faster going forward.
Trusts will be scored into four performance segments, with the first segment representing the best performing areas and the fourth segment showing the most challenged. To enable fairer comparisons, separate league tables are published for acute, non-acute and ambulance trusts.
Those trusts in middle segments of the tables will be encouraged to learn from top performers to help them improve on their rankings, so they too will be able to financially benefit from their budget surpluses in the future.
The league tables deliver on a key commitment in the government’s 10 Year Health Plan to improve transparency, reward high performance and intervene to poor performance across the NHS.
By summer 2026, the tables will expand to cover Integrated Care Boards – NHS organisations responsible for planning health services for their local population – and wider areas of NHS performance.
This builds on progress already delivered through the government’s Plan for Change, including cutting waiting lists by over 250,000 since July 2024, delivering almost 5 million extra appointments, and 2,000 additional GPs recruited to make it easier for patients to book appointments.
BACKGROUND
- Each trust is scored against metrics in the National Oversight Framework (NOF), which reflect the delivery of NHS priorities, including performance against targets like reducing wait times for electives and A&E, and improving ambulance response times.
- Each trust is ranked by average metric score and assigned to one of the four equal ‘segments’ (performance categories) informing the improvement support each receives from NHS England.
- Reflecting the need for the NHS to recover financially, any trust in deficit can be no higher than segment 3, and those initially placed in segments 1 or 2 will have their segment adjusted regardless of wider performance.
- Trusts are then ranked within their category (acute, non-acute, or ambulance) based first on this adjusted segment classification and then by their average metric scores to determine their league table position.
- NHS leaders will receive extra pay incentives to go into challenged trusts and turn them around. Where trusts are persistently failing, senior managers could see their pay docked – this forms part of broader work to improve how to support and strengthen management and leadership across the NHS.
- Alongside this, higher standards will be set for leaders, with pay tied to performance. Experience and feedback will be central to where trusts are ranked, giving patients more power to be able to have their say. There will be a failure regime to bring poor performers up to standard.
- Organisational performance in the NHS is a complex concept to express simply. The league tables rank trusts based on average of scores across the NHS Oversight Framework performance metrics. This can obscure variations in performance in specific areas.
- A trust’s segmentation classification is the overall assessment of an organisation’s performance.
- Differences in average performance of trusts near to each other in the league tables are also unlikely to be significant and could be marginal.
- Rankings should only be used as a guide to where an organisation roughly sits amongst its peers, rather than a definitive judgement of whether one trust is considered to be “better” than another.
- Unlike CQC assessments, the NOF measures relative rather than absolute performance. NOF segments are initially determined by performance quartiles. This means that there will always be 25% of trusts in each, regardless of improvement or deterioration in performance.
