“Trusts ranked quarterly on care standards, with leaders’ pay tied to results”

For the first time in its history, the NHS has published league tables ranking every trust in England, exposing the best and worst performers across the health service.

The Department of Health and Social Care (DHSC) confirmed the new system will see trusts assessed quarterly on standards ranging from A&E performance and elective surgery to mental health provision. The move is part of the government’s 10-year reform plan and is designed to end the so-called “postcode lottery” in patient care.

Trusts are divided into four categories: the first recognises top performers, while the fourth highlights those delivering the poorest standards. To ensure comparisons are fair, rankings are grouped separately for acute, non-acute and ambulance trusts.

Incentives and penalties
Top-tier trusts will be granted greater freedoms and fresh investment, while middle-ranking organisations will be encouraged to learn from the best. Poorer performers will receive targeted intervention — but also face tougher accountability.

From next year, senior leaders at persistently failing trusts could see their pay docked, while the best NHS managers will be offered higher salaries to take on the most difficult jobs. Performance-linked pay, the government says, will sharpen incentives to deliver results.

Health Secretary Wes Streeting insisted the league tables will provide transparency and force improvement. “We must be honest about the state of the NHS to fix it,” he said. “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 cut waiting times and deliver value for money.”

The government will also expand the Foundation Trust model, giving the best hospitals more autonomy to tailor services to local needs.

Transparency or panic?
Officials stress the rankings are designed to empower patients, not frighten them. Ashish Joshi, Sky News health correspondent, admitted his first instinct on seeing the list was to check where the trusts that cared for him and his family had ranked — a reaction many patients are expected to share.

“The danger is people see their trust in segment four and panic,” he said. “But the aim here is not to name and shame. It’s to drive improvement, ensure accountability, and raise standards for everyone.”

Patients will also be asked to provide feedback that feeds into future gradings, strengthening their voice in how the NHS is judged.

NHS England backs move
Sir Jim Mackey, chief executive of NHS England, welcomed the initiative, saying: “Letting patients and the public access more data will help to drive improvement even faster. It supports them to identify where they should demand better from their NHS and puts more power in their hands to make informed decisions.”

The league tables will expand again by summer 2026, covering integrated care boards — the regional NHS bodies responsible for planning services locally.

Ending the postcode lottery
The publication of trust-by-trust rankings marks a cultural shift for the NHS, long criticised for inconsistent standards across England. The government hopes transparency will drive reform by exposing weak spots and rewarding excellence.

But critics warn the risk of competition could undermine collaboration between hospitals. Ministers counter that without honest comparisons, patients cannot know whether they are receiving the care they deserve.

Streeting insists the policy will “shine a light on performance” and push the health service towards consistent quality. Whether the public views the tables as a tool for accountability or a source of anxiety remains to be seen