For the first time, the Department of Health and Social Care has published “league tables” for NHS trusts in England, ranking them based on performance.

Partner, Steven Brown and Trainee Solicitor, Alex Tickle, in JMW’s Clinical Negligence team, discuss the league table and what NHS trusts can learn from the results.

Why have the league tables been introduced?

In November 2024 the government announced that NHS trusts would be assessed against a range of performance criteria as part of its “Plan for change” in ensuring improvements within the NHS, leading to better care and access for patients. Trusts across England will now receive a quarterly ranking in comparison to other trusts.

This ranking is based on a range of factors including hospital wait times, ambulance response times and patient access to care. The league tables will aid in identifying where support is needed, and encourage the top-performing trusts to share their practices with those of a lower ranking.

The top-performing trusts will receive incentives, such as increased investment opportunities, whereas lower ranking trusts could face potential pay deductions if they continue to be ranked poorly. This aims to create an incentive for overall improvement and equalised levels of care and treatment being provided across NHS hospitals in England.

Who has the highest ranking?

The league tables have now been published by the department of Health and Social Care, and are divided into 3 sections:

i. Acute trusts – those that provide acute care including treatment, accident and emergency facilities and specialist medical care,

ii. Non-acute trusts – those that provide mental health and disability treatment, and treatment for other non-emergency medical needs, and

iii. Ambulance trusts.

According to the rankings published 9 September 2025, some of the top-performing acute trusts include Moorfields Eye Hospital, The Christie and The Walton Centre. The highest ranked non-acute trust is currently North Staffordshire Combined Healthcare NHS Trust, specialising in mental health, learning disability, and primary care treatment. At present, the top performing ambulance trust is the North West Ambulance Service.

Are the league tables a fair reflection?

Although the introduction of league tables aims to create greater transparency, there remains the question of whether a single numerical ranking can be a fair reflection of the NHS trust as a whole. Whilst a ranking may aid to identify those trusts where improvements may be necessary, this potentially fails to differentiate the performance levels across departments within a hospital, and further fails to acknowledgement the differing performance between multiple hospitals that are governed by one trust.

External factors can further affect the performance of these organisations, including the time of year with hospitals seeing an increase in patients during the winter months. These pitfalls may result in the data produced in the league table lacking accuracy and incorrectly reflecting the true performance of hospitals across England.

The league tables have been introduced to promote greater transparency for patients and between the hospitals trusts to seek an overall improvement in performance. However there are concerns that patients also need to be informed of what is being actively done to improve the lower ranking trusts as opposed to simply identifying those in need of further support.

With the introduction of a brand-new concept, it may be that with time we see a refinement to the league tables to address the potential pitfalls. It will be interesting to see if any changes are made to the next league tables, when published in three months’ time