NHS trust league tables arrive in UK health shakeup
The UK government has published a list of the best- and worst-performing NHS trusts in England for the first time, part of a drive to end the 'postcode lottery' of care.
Health Secretary Wes Streeting said the quarterly rankings – part of the government's ongoing effort to reset the NHS under its 10-Year Plan – will pinpoint where urgent support is needed, while allowing the top-ranked trusts greater freedom and investment.
"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," he said. "These league tables will identify where urgent support is needed and allow high-performing areas to share best practices with others, taking the best of the NHS to the rest of the NHS."
The move has come in for some criticism already, however, with The King's Fund think tank saying that the value of the rankings to the public "is questionable, because hospital performance is not as simple as good or bad. There is no consistent relationship between how well a hospital trust ranks on its four-hour A&E waiting times and how well it ranks on its 18-week elective waiting times or 28-day faster cancer diagnosis."
Meanwhile, the Nuffield Trust pointed to "shortcomings" in the league table approach as the calculations "only cover certain things, and can't include many clinical outcomes, such as cancer survival rates."
One issue that has been highlighted is the assessment of finances, which might mean that a hospital scoring well for clinical care will be marked down if it is overspending on its budget.
The top-ranked trust in England is Moorfields Eye Hospital NHS Foundation Trust, followed by the Royal National Orthopaedic Hospital NHS Trust and the Christie NHS Foundation Trust, which focuses on cancer.
At the other end is the Queen Elizabeth Hospital in King's Lynn, the Countess of Chester Hospital – made famous by the case of Lucy Letby, a former neonatal nurse convicted of the murders of seven infants and the attempted murders of several others – and University Hospitals Coventry and Warwickshire.
"The government should open up a conversation with the public on the level of detail that would be most meaningful to them," said Danielle Jefferies, senior analyst at The King's Fund.
"One option is to make rankings more granular so that individual hospitals and departments within hospitals get separate rankings. Another option is to have a ranking system comparing trusts to their individual performance improvement goals that have been set centrally, rather than comparing them with other trusts."
The results suggest that hospitals providing specialist services tend to score better than those offering more general care, although the government said that – to enable fairer comparisons – separate league tables are published for acute, non-acute, and ambulance trusts.
By summer 2026, the tables will expand to cover Integrated Care Boards (ICBs) – the organisations responsible for planning health services for local populations – and wider areas of NHS performance.
"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," said NHS England's chief executive, Sir Jim Mackey.
"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 in their hands to make informed decisions on their choice of provider."
