New NHS Trust Performance Rankings Aim to Improve Transparency and Accountability
The Department of Health and Social Care (DHSC) has released the first-ever league tables showcasing the best and worst-performing NHS trusts in England. These quarterly rankings are intended to identify areas where urgent support is needed and to reduce the so-called “postcode lottery” that affects patient care across different regions.
Health Secretary Wes Streeting emphasized that the new system will allow patients and taxpayers to understand how their local NHS services compare to others nationwide. He stated that the rankings will help high-performing areas share best practices with those struggling, ultimately improving overall service quality.
However, some experts have raised concerns about the effectiveness of these rankings. They argue that hospital performance is complex and cannot be simplified into a single score of “good” or “bad.” The DHSC has developed a scoring system based on various factors, including financial health, access to care, waiting times for operations and A&E, and ambulance response times. Trusts are divided into four categories, with the top performers receiving more freedom and investment.
Moorfields Eye Hospital NHS Foundation Trust ranks first, followed by the Royal National Orthopaedic Hospital NHS Trust and The Christie NHS Foundation Trust. Northumbria Healthcare NHS Foundation Trust is the highest-ranked large hospital trust, placing ninth overall. On the other end of the spectrum, Norfolk and Suffolk NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Sussex Partnership NHS Foundation Trust, and Devon Partnership Trust are among the worst-performing trusts. Birmingham Community Healthcare NHS Foundation Trust is at the bottom of the list.
The DHSC plans to raise the bar for leadership within trusts, tying pay to performance. Senior managers at consistently underperforming trusts may face pay cuts, while leaders who take on challenging trusts could receive additional incentives. Middle-ranking trusts will also be encouraged to learn from top performers to improve their standings.
Streeting highlighted the importance of transparency, stating that patients deserve to know how their local NHS services are performing compared to the rest of the country. He believes the league tables will help address the postcode lottery and ensure that the best practices from high-performing areas are shared more widely.
Meanwhile, the British Medical Association (BMA) has announced that doctors in their first year of training in England will vote on potential industrial action due to a shortage of training places. The union is pushing for an increase in available training spots, which could be part of ongoing discussions with the government over pay disputes.
Separate rankings have been published for acute, non-acute, and ambulance trusts. North West Ambulance Trust leads the list, followed by East Midlands Ambulance Trust and Yorkshire Ambulance Trust. East of England Ambulance Trust is ranked the lowest.
Starting next summer, the league tables will expand to include integrated care boards, which are responsible for planning health services at the local level. Sir James Mackey, chief executive of NHS England, said that increased data access will help drive improvements by enabling patients to demand better services.
Despite these efforts, some analysts caution that a single ranking may not provide a full picture of hospital performance. Danielle Jefferies, senior analyst at The King’s Fund, noted that a single ranking can obscure variations in performance across different departments within the same hospital and between multiple sites run by a single trust.
Chris McCann, deputy chief executive of Healthwatch England, emphasized the need for transparency paired with accountability. Patients want clarity on how their local NHS is performing and expect to see concrete actions being taken to address issues.
Daniel Elkeles, chief executive of NHS Providers, stressed that more work is needed to ensure the league tables accurately reflect the best-performing organizations. For the rankings to truly drive improvement, they must measure the right factors, use accurate and objective data, and avoid focusing on elements outside the control of individual providers.
The new league tables follow the release of an NHS England online dashboard designed to give the public more insight into how local health services compare. Trusts are evaluated using seven key performance measures, including waiting times, cancer treatment, time spent in emergency departments, and diagnostic test wait times.
