NHS league tables: why thoughtful design is essential

In this long read, Joe Kiely from the NHS Confederation, and Izzy Allen from NHS Providers, set out a joint view on the upcoming publication of leagues tables for NHS trusts. While many trust and ICB leaders recognise the potential of league tables to drive improvement and enhance public transparency, they all emphasise the importance of careful design and implementation to avoid the risk of unintended consequences. Based on feedback from healthcare leaders, we offer recommendations to help league tables better serve the government, healthcare leaders and importantly, the public. 

Introduction

In November, following a major boost to NHS funding in the Autumn Statement, the health secretary announced plans to reintroduce NHS league tables. The move is part of a broader reform agenda aimed at tackling underperformance and ensuring there are 'no more rewards for failure'. The government's 10-year health plan also positions league tables as a tool to empower patients by promoting 'transparency, voice and choice'.

Starting in early autumn, quarterly rankings will be published for acute, mental health, community and ambulance trusts as part of a new public facing dashboard. These rankings will be linked to the NHS Oversight Framework 2025/26 (NOF), which assesses trusts using a set of primarily short-term, operational metrics and a financial override. Together, these produce an organisational delivery score ranging from 1 (high performing) to 4 (low performing). This score determines each trust's NOF segment and therefore its position in a league table. 

The importance of getting league tables right

Healthcare leaders share the government's ambition to improve performance and ensure that NHS funding delivers value for taxpayers. They also support a robust oversight regime – one that acknowledges excellence, sets clear consequences for underperformance and provides tailored support to those who need it. 

League tables can be an impactful part of that, driving improvement by encouraging healthy competition, increasing local accountability and sharpening the focus of trust leaders on national priorities. However, history suggests the government should proceed with care. Many healthcare leaders recall that while the last Labour government's NHS 'star ratings' contributed to a reduction in waiting times, they were eventually scrapped due to concerns about their effectiveness. 

If not carefully designed and implemented, performance measurement systems can lead to unintended consequences - especially if used principally to 'name and shame'. It matters what metrics are used, the quality and consistency of data, how the information is presented to the public and the nature of the regulatory response.

The first year of implementation will inevitably bring teething issues, which NHS leaders and staff appreciate. However, appreciating this won't stop them having understandable anxieties, particularly those who feel the data is not robust enough and fear being unfairly penalised or subjected to undue public criticism. It is therefore essential that the government continues to respond quickly and transparently to any issues that arise, so that trusts feel supported and retain trust in the process. NHS England's (NHSE's) open approach to feedback so far has been appreciated by trust leaders, as has the decision to delay publication while efforts are made to improve the data quality and comparability. 

We are committed to working with the government to give league tables the best chance of success. As part of this, we propose four tests the government should apply to its league tables before publishing them later this year.