NHS trusts in England have been ranked in a ‘pioneering’ new system of league tables by the government.
Every trust in England will be ranked quarterly against clear, consistent standards – from urgent and emergency care, to elective operations and mental health services.
The Department of Health and Social Care said the data marks a “new era of transparency and accountability” in the NHS, with league tables delivering on the government’s promise to drive up standards, tackle variation in care, and ensure people get the high-quality service they expect.
NHS league tables
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Health secretary Wes Streeting said: “We must be honest about the state of the NHS to fix it. Patients and taxpayers have to know how their local NHS services are doing compared to the rest of the country.
“These league tables will identify where urgent support is needed and allow high-performing areas to share best practices with others, taking the best of the NHS to the rest of the NHS.
“Patients know when local services aren’t up to scratch and they want to see an end to the postcode lottery – that’s what this government is doing. We’re combining the extra £26bn investment each year with tough reforms to get value for money, with every pound helping to cut waiting times for patients.”
Sir Jim Mackey, chief executive of NHS England, said: “NHS staff across the country work flat out to deliver the highest standard of care to their patients, and every day we see or hear fantastic examples of this, but we still have far too much unwarranted local variation in performance.
“Letting patients and the public access more data will help to drive improvement even faster by supporting them to identify where they should demand even better from their NHS and by putting more power in their hands to make informed decisions on their choice of provider.
“The data also supports local NHS trust boards and leadership teams to more easily identify the highest performing services in the NHS and adapt how they deliver care to drive improvement even faster going forward.”
Three league tables have been published today, ranking acute, non-acute and ambulance trusts. By next summer, they will be expanded to include integrated care boards, the NHS organisations responsible for planning health services for their local population.
NHS leagues tables: acute, non-acute and ambulance trusts
Trusts facing the greatest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-related pay. The best NHS leaders will be offered higher pay to take on the toughest jobs, moving them into challenged services and turning them around.
Matthew Taylor, chief executive of the NHS Confederation, said: “League tables, when thoughtfully designed and effectively implemented, can be a valuable tool for fostering healthy competition and enhancing local accountability. Many NHS leaders will support their use if they genuinely help drive improvement.
“The priority must be ensuring these tables provide meaningful, accurate information that empowers patients to make informed choices and enables NHS organisations to share best practice and learn from one another.”
However, he warned that NHS league tables must not become instruments of blame. “We must guard against the risk of perverse incentives and ensure that the metrics used are transparent, relevant, and presented clearly,” he said. “Poorly constructed tables could mislead patients or invite misplaced scrutiny from politicians and the media.
“To be truly effective, league tables must be objective, reflect what matters most to the public, and avoid penalising high-performing trusts that are contributing to wider system recovery. Above all, they should support improvement, not undermine it.”
‘Questionable’
Writing in a blogpost yesterday, Danielle Jefferies, a senior analyst at the King’s Fund think tank, said: “Whether these league tables will be helpful to the public is questionable, because hospital performance is not as simple as good or bad.
“For example, if a hospital has good A&E waiting times, you might assume that that good performance would be reflected elsewhere in the hospital. In reality, there is no consistent relationship between how well a hospital trust ranks on its four-hour A&E waiting times and how well it ranks on its 18-week elective waiting times or 28-day faster cancer diagnosis.
“A trust with a high-ranking A&E performance could be the best, the worst or mediocre on its elective waiting-list time and cancer diagnosis times.”
Daniel Elkeles, chief executive of NHS Providers, said: “There’s more work to do before patients, staff and trusts can have confidence that these league tables are accurately identifying the best performing organisations.
“For league tables to really drive up standards, tackle variations in care, and boost transparency, they need to measure the right things, be based on accurate, clear and objective data and avoid measuring what isn’t in individual providers’ gift to improve. Then they will drive improvement and boost performance.
“Anything less could lead to unintended consequences, potentially damaging patient confidence in local health services, demoralising hardworking NHS staff and skewing priorities.”
How do NHS league tables work?
Trusts are scored into four performance segments, with the first segment representing the best-performing areas and the fourth segment showing the most challenged. To enable fairer comparisons, separate league tables are published for acute, non-acute and ambulance trusts.
Those trusts in the middle segments of the tables will be encouraged to learn from top performers to help them improve on their rankings, so they too will be able to benefit financially from their budget surpluses in the future.
To be truly effective, league tables must be objective, reflect what matters most to the public, and avoid penalising high-performing trusts that are contributing to wider system recovery. Above all, they should support improvement, not undermine it” – Matthew Taylor, NHS Confederation
Each trust is scored against six metrics in the NHS Oversight Framework (NOF), measuring: strategy, leadership and planning; quality of care; people and culture; access and delivery of services; productivity and value for money; and financial performance and oversight.
Trusts are ranked by an average score and assigned to one of four equal segments, which will inform the improvement support each will receive. Any trust in financial deficit can be no higher than segment 3.
Trusts are then ranked based first on this adjusted segment classification and then by their average metric scores to determine their league table position.
Where trusts are persistently failing, senior managers could see their pay docked.
The DHSC said a trust’s segment classification is the overall assessment of an organisation’s performance and that differences in average performance of trusts near to each other in the league tables are unlikely to be significant and could be marginal.
It added that rankings should only be used as a guide to where an organisation roughly sits amongst its peers, rather than a definitive judgement of whether one trust is considered to be “better” than another.
Unlike assessments by the Care and Quality Commission (CQC), the NOF measures relative rather than absolute performance. NOF segments are determined by performance quartiles, meaning there will always be 25% of trusts in each, regardless of improvements or deterioration.
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