Preparing for league table publication: our four tests

Based on engagement with trust and Integrated Care Board (ICB) leaders, we propose four tests the government should apply to league tables before publishing them. For each test, we offer recommendations to help ensure league tables have the best chance of success.

1. Do league tables provide an accurate and objective account of organisational performance?

• The Department of Health and Social Care (DHSC) and NHSE should establish a clear feedback mechanism to help strengthen the accuracy and objectivity of the metrics and methodology underpinning league tables. We recommend three key actions:
  • Refine the financial override mechanism to more reliably identify organisations experiencing genuine financial challenges and to take account of arrangements to improve wider system finances.
  • Avoid unreliable metrics where data quality is compromised due to systemic constraints and provide targeted support to help trusts strengthen their data infrastructure and capabilities. 
  • Publicise the technical guidance detailing the scoring methodology for each metric to ensure transparency and help trusts understand their ratings. 

2. Do league tables provide a measure of the issues that matter most to the public?

• NHSE’s review of the 2026/27 Oversight Framework should assess which metrics best support meaningful transparency and local accountability, ensuring there is a greater emphasis on patient priorities in the future.

3. Is it clear to the public what league tables do and do not show? 

• When the new public-facing dashboard is launched, DHSC and NHSE should provide a clear and accessible explanation of what the data does and does not show to help users understand its purpose and limitations of league tables.

4. Has the risk of perverse incentives been mitigated?

• DHSC and NHSE should actively monitor the impact of league tables for unintended consequences, including effects on system collaboration, staff wellbeing, quality and safety and recruitment to ‘challenged’ organisations. 
• To support public transparency and accountability, DHSC and NHSE should publish their findings on a regular basis – for example, by providing an update to the NHSE Board every 6 months.