Government publishes first NHS league tables, naming worst-performing hospital trusts

The government on Monday published the first official, public league tables ranking every NHS trust in England, naming the services judged to be worst performing and setting out a programme of targeted support, incentives and greater freedoms for top performers.

The Department of Health and Social Care (DHSC) said the quarterly rankings cover hospitals, ambulance services and mental health providers and are based on a range of measures including finances, patient access to care, waiting times for operations and emergency departments, and ambulance response times. Mid and South Essex Foundation Trust was identified as the worst performing large hospital trust, followed by Worcestershire Acute Hospitals NHS Trust. Queen Elizabeth Hospital, King's Lynn NHS Foundation Trust and Countess of Chester Hospital NHS Foundation Trust were among the lowest-ranked small trusts. Moorfields Eye Hospital topped the overall list, with the Royal National Orthopaedic Hospital NHS Trust and The Christie NHS Foundation Trust also among the highest scorers.

Health Secretary Wes Streeting said the move is intended to "end the postcode lottery" of care by making performance transparent and by directing resources and management support to struggling services. In a column published alongside the release, Streeting said the tables would be updated every three months and would allow high-performing areas to share best practice, while trusts persistently ranked poorly could face pay penalties for senior managers and more intensive intervention. The DHSC said top-ranked organisations will receive greater freedoms and investment, and that additional payments will be offered to experienced NHS leaders who take on the most challenged trusts.

NHS England chief executive Sir James Mackey said wider access to the data should help patients decide where to demand better care and would accelerate improvement. The DHSC also published separate rankings for ambulance services, with the East of England rated lowest among regional ambulance trusts. The department said the scheme will be expanded next summer to include integrated care boards, which plan local services, and to cover a broader set of performance measures.

Patient groups and sector bodies gave cautious welcomes but warned against over-simplification. Chris McCann, deputy chief executive of Healthwatch England, said people want clarity on local services but that transparency must be accompanied by clear plans to fix problems and timelines for improvement. Danielle Jefferies, a senior analyst at The King's Fund, cautioned that a single ranking can obscure variation in performance between departments and across multiple sites run by a single trust. Daniel Elkeles, chief executive of NHS Providers, said the tables need to measure the right things, be based on clear and objective data, and avoid holding trusts to account for factors beyond their control before they can reliably drive improvement.

Trust leaders warned the rankings risk turning staff into "instruments of blame" if used punitively. The DHSC said the intention is to combine targeted support with accountability and that any penalties would be tied to persistent underperformance.

The publication of the league tables comes as separate NHS monthly data for England show pressures persisting across the system. In June, more than 7.37 million treatments relating to about 6.23 million patients were waiting for routine hospital care, the NHS data show, with more than 190,000 people waiting at least a year for treatment. The same monthly figures indicated that around 1,000 patients faced waits of at least 12 hours in emergency departments each day in June.

Officials said the new rankings are intended to sit alongside existing performance metrics and to provide a single, regularly updated view so local areas, national bodies and patients can see comparative performance. The DHSC said high performers will be allowed to retain surpluses for reinvestment and to operate with fewer central controls, while middle-ranking trusts will be encouraged to learn from leaders and those at the bottom will receive targeted interventions.

Hospital performance has been a recurrent issue for successive governments, and ministers are framing the league tables as part of a wider plan to rebuild the health service. Streeting said the government has invested an additional £26 billion this year and that reform to improve value for taxpayers is needed alongside funding increases. He pointed to recent measures the government says have reduced waiting lists and increased appointments and GP numbers, while acknowledging there is more to do to shorten waits and improve patient experience.

NHS bodies and analysts said the usefulness of the new rankings will depend on the clarity of the metrics, regular updates, and the degree to which local and national leaders use the information to support improvements rather than simply to punish. The DHSC said it will review and expand the tables over time and that publication every three months will allow progress to be tracked.

The release of the tables is likely to prompt scrutiny from patients, local politicians and media, with ministers arguing the initiative will make performance differences visible and accelerate action to tackle entrenched problems. Critics said greater transparency must be matched by careful interpretation of the data and by support for frontline staff and managers working in the most challenged services.