Government publishes first NHS league tables, names lowest-performing hospitals in England

The government has for the first time published league tables ranking every NHS trust in England, naming the lowest-performing hospital trusts and ambulance services as part of a bid to increase transparency and drive improvement.

The Department of Health and Social Care said the rankings identify trusts that are delivering substandard care and those that are performing well. Mid and South Essex Foundation Trust was listed as the worst-performing large hospital trust, followed by Worcestershire Acute Hospitals NHS Trust. The Countess of Chester Hospital NHS Foundation Trust, Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust and others were singled out among the lowest-ranked smaller trusts. Specialist providers dominated the top of the list, with Moorfields Eye Hospital ranked first, followed by the Royal National Orthopaedic Hospital and The Christie NHS Foundation Trust. Northumbria Healthcare was the highest-ranked large hospital trust at number nine.

The ranking scores are based on a range of measures including financial performance, patient access to care, waiting times for elective operations and emergency department waits, and ambulance response times. Separate tables were published for ambulance trusts, with the East of England ranked lowest. The government said the tables will be updated every three months and expanded from next summer to cover integrated care boards, which plan local services.

Health Secretary Wes Streeting said the move is intended to "end the postcode lottery" of care and to pinpoint where urgent support is needed. In a column accompanying the launch he said the tables would allow high-performing areas to share best practice, give top trusts greater freedoms and investment, and ensure underperforming trusts receive targeted interventions. The department said senior managers at trusts that are persistently ranked poorly could face docking of pay, while incentives will be offered to leaders willing to take on challenged services.

Sir James Mackey, chief executive of NHS England, said giving patients access to more data "will help to drive improvement even faster by supporting them to identify where they should demand even better from their NHS." Patient group Healthwatch England welcomed the additional clarity but said transparency must be paired with accountability and clear plans for improvement.

Independent analysts and trust leaders urged caution about interpreting the tables as definitive measures of quality. Danielle Jefferies, a senior analyst at The King’s Fund, said "a single ranking cannot give the public a meaningful understanding of how good or bad a hospital is," warning that composite scores can hide variation in performance across different departments and multiple hospital sites within the same trust. Daniel Elkeles, chief executive of NHS Providers, said the tables will need to measure the right things and be based on clear and objective data for them to drive improvement rather than sow confusion.

The publication of the league tables coincides with official NHS monthly data showing pressure on services. In June, more than 7.37 million hospital treatments — relating to 6.23 million patients — were waiting for routine elective care, including more than 190,000 people waiting at least a year. Separate performance data reported around 1,000 patients faced waits of at least 12 hours in emergency departments each day in June.

Supporters of the tables said the rankings create accountability and a mechanism to reward strong performance and target resources. Critics, including some trust leaders, warned of the risk that staff could be turned into "instruments of blame" if results are used punitively rather than to support improvement.

The government said top-performing trusts will receive freedoms from central micromanagement, including the ability to reinvest budget surpluses, while mid-ranked trusts would be encouraged to learn from leaders and those at the bottom would receive targeted interventions and scrutiny. The department also said it will offer higher pay to experienced leaders willing to take on the toughest roles to turn around struggling services.

Officials said the step is part of broader reforms aimed at improving value and reducing variation in care, alongside recent investments in staff and services. NHS England and the Department of Health and Social Care said they will monitor the impact of the league tables and refine the methodology over time to better reflect the diversity of services provided by different trusts.

Patient groups and analysts said ongoing monitoring and clearer explanation of what the scores mean at service and site level will be essential if the tables are to be useful to patients deciding where to seek care. The government has said the publication is designed both to inform patients and to concentrate support where it is most needed, but acknowledged the data will be only one part of how the health service’s performance is judged going forward.