Key Summary
- NHS aims to bring in greater transparency and accountability, drive up overall standards, and tackle variation in care
- Top-performing trusts will be rewarded with greater autonomy, including the ability to reinvest surplus budgets into frontline improvements
- Trusts facing the greatest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-linked pay
NHS trusts in England will be ranked quarterly in the league tables, with better performers getting rewards.
The scores are based on factors including A&E waits, waiting times for routine operations, and the size of financial deficits.
NHS aims to bring in greater transparency and accountability, drive up overall standards, tackle variation in care, and ensure high-quality service for people.
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.
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.
Moorfields Specialist Eye Hospital in London tops the table, followed by the Royal National Orthopaedic Hospital NHS Trust, and The Christie NHS Foundation Trust.
Among ambulance trusts, North West Ambulance Service is in the top of the list, followed by East Midlands Ambulance Service.
The East of England Ambulance Service has been rated the worst-performing in the country.
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.
Health secretary Wes Streeting 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.
"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."
NHS England chief executive Sir Jim Mackey 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."
Nuffield Trust objection
However, some experts have raised their objections to the NHS League Table.
Nuffield Trust chief executive Thea Stein said, “The calculations only cover certain things, and can’t include many clinical outcomes, such as cancer survival rates. There’s a risk that trusts will focus only on the measures that immediately boost their ranking, even if that’s not necessarily what’s best for patients. As finances have a particular sway on the rankings, this is of limited use for patients trying to choose the best hospital for their care.
“The scheme also risks discouraging people from getting treatment from poorly performing trusts, or staff from working for them. This is a particular concern for small or remotely situated trusts whose ranking may be down to things outside their control, like the quality of their buildings or difficulty in attracting and retaining staff. The league tables approach cannot come at the expense of addressing long-term systemic issues like these.”
The King's Fund senior analyst Danielle Jefferies said in a blog post, "A single ranking cannot give the public a meaningful understanding of how good or bad a hospital is. A single ranking hides the variation in performance across different departments within the same hospital. And a single ranking by trust also hides the variation in performance that can exist across the multiple hospital sites that are often run by a single trust."
