2. Do league tables reflect the issues that matter most to the public?

We fully support the ambition in the 10-year health plan to improve public transparency, voice and choice. League tables aim to support this by helping to present complex information in a clear and accessible way. 

However, for league tables to truly serve the public, the metrics that underpin them must reflect what the public and patients care about most. By linking league tables to the Oversight Framework, the government has introduced a potential tension between regulatory and patient priorities. 

Take the financial override, for example. While financial management is an important part of organisational oversight, it is unlikely to be a key concern for patients choosing where to receive care. Instead, they want to know which hospital has the best health outcomes, patient experience and the shortest waits. This raises a concern: will people understand that a hospital ranked lower in the league table might still provide high-quality, safe care? 

Similarly, the league tables will present data at a trust level, rather than the specific services or care pathways that patients engage with. Assessments by the Care Quality Commission show performance can vary substantially within hospitals.

Research by the King's Fund shows that, in practice, most patients choose their local provider, even when given the option to travel elsewhere. When exercising choice, decisions typically rely on their GP's advice or on past experience. Notably, those from the most deprived socioeconomic areas are least likely to exercise choice when it was available, which may contribute to widening health inequalities. Importantly, this research also found that increasing patient awareness of choice did little to focus providers on improvement because so few patients exercise it. 

The limitations outlined make league tables, on their own, ill-suited to guide patient choice. Yet, as the government rightly encourages people to take a more active role in their healthcare and wellbeing, there is a risk the league tables will be used in exactly this way. 

Ahead of 2026/27, the government is reviewing the framework to incorporate work to implement the ICB operating model and align with priorities set out in the 10-year health plan.

As part of this process, we recommend assessing what metrics would most effectively promote meaningful transparency and local accountability including by working closely with patient representative groups. If league tables remain tied to the Oversight Framework in 2026/27, the metrics selected for public-facing league tables should place greater emphasis on patient priorities, with analysis of how the updated list of metrics will contribute to public transparency.