For the first time in the history of England’s National Health Service, every NHS trust has been publicly ranked in a new set of league tables—an ambitious move by the Department of Health and Social Care (DHSC) to drive up standards, boost transparency, and deliver better value to patients. The rankings, published on or before September 9, 2025, have already ignited debate across the country, particularly in regions where hospitals found themselves near the bottom of the list.
Among the most striking results, the North Cumbria Integrated Care NHS Foundation Trust (NCIC), which manages the Cumberland Infirmary and West Cumberland Hospital, was ranked joint 130th out of 134 acute hospital trusts in England. According to BBC, this low standing reflects deeper, structural challenges unique to rural and remote health systems. A spokesperson for NCIC acknowledged, “NCIC’s rating is disappointing, but reflects the real structural challenges we face as a rural, remote health system and supports what the new NHS 10-year plan calls for in rethinking how care is delivered across the NHS.” Despite the disappointing rank, they emphasized that the trust has “stabilised” and is “improving” compared to four years ago. “The whole NCIC team share a determined focus on improving performance so that we provide better care for our patients,” the spokesperson added.
In stark contrast, Northumbria Healthcare NHS Foundation Trust soared to ninth place nationally, a result attributed to the dedication and commitment of its staff. Dr Birju Bartoli, the trust’s chief executive, told BBC, “These high standards are driven by the hard work and dedication of our teams across the trust, who are committed to providing the best possible care for the communities we serve in Northumberland and North Tyneside.” Other regional trusts landed at various spots: South Tyneside & Sunderland at 21st, North Tees & Hartlepool at 22nd, Newcastle upon Tyne Hospitals at 26th, County Durham & Darlington at 66th, South Tees at 82nd, and both Gateshead Health and Morecambe Bay at joint 83rd.
But how did these rankings come about, and what do they actually mean for patients and NHS staff? According to ITV News, the league tables form part of the government’s Plan for Change, which aims to improve NHS services by offering greater investment and autonomy to top-performing trusts, while underperformers receive targeted support. Every trust is now ranked quarterly against key standards, including urgent and emergency care, elective operations, and mental health services. The aim, as NHS England put it, is to “help end the postcode lottery in care, ensuring patients receive timely, high-quality treatment wherever they live.”
Specialist hospitals dominated the top spots. Moorfields Eye Hospital NHS Foundation Trust was crowned the best-performing trust, followed closely by the Royal National Orthopaedic Hospital NHS Trust and The Christie NHS Foundation Trust. At the bottom end, trusts like Norfolk and Suffolk NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Sussex Partnership NHS Foundation Trust, and Devon Partnership Trust struggled, with Birmingham Community Healthcare NHS Foundation Trust ranked last.
The league tables are divided into four segments. The first segment represents the best performers, while the fourth includes those facing the greatest challenges. The rankings are not just for acute care trusts—non-acute and ambulance trusts are also included. In the ambulance category, North West Ambulance Service took first place, while North East Ambulance Service was fifth out of ten. These segments are determined by scores from the National Oversight Framework (NOF), which measures delivery of NHS priorities such as A&E waiting times and ambulance response times. Trusts in financial deficit cannot rank higher than segment three, regardless of other metrics.
The stakes are high for NHS leaders as well. ITV News reported that senior NHS leaders will now see their pay linked to their trust’s performance. The best leaders will be offered higher pay to take on some of the most challenging roles, with an explicit expectation that they will help turn struggling services around. “Trusts facing the greatest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-linked pay,” NHS England said in a statement.
Health and Social Care Secretary Wes Streeting defended the new system, saying, “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.” He also highlighted the combination of an extra £26 billion investment each year with “tough reforms” to “get value for money.”
Yet the introduction of league tables has not been without controversy. Critics argue that a single ranking oversimplifies the complex reality of hospital performance. Danielle Jefferies, a senior analyst at healthcare charity The King’s Fund, told ITV News, “A single ranking cannot give the public a meaningful understanding of how good or bad a hospital is. Whether NHS trust league tables will be helpful to the public is questionable, because hospital performance is not as simple as good or bad.” She added that such rankings “hide the variation in performance across different departments within the same hospital” and “hide the variation in performance that can exist across the multiple hospital sites that are often run by a single trust.”
Even the DHSC acknowledged the limitations, stating that the rankings should 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.” The NOF’s relative scoring method ensures that 25% of trusts will always fall into each segment, regardless of whether overall standards improve or decline.
For patients, these league tables could mean greater transparency and a louder voice in shaping local care. NHS England emphasized that “patient feedback will also play a central role in how trusts are ranked, giving people a stronger voice in shaping their care.” For trusts like NCIC, the new system is both a challenge and an opportunity—a call to address the unique difficulties of rural healthcare delivery while striving to learn from the top performers.
As the league tables are set to be updated every three months, NHS staff, patients, and policymakers alike will be watching closely to see if this new era of accountability leads to real improvements on the ground—or simply adds another layer of bureaucracy to an already complex system. For now, the rankings have shone a spotlight on both the best and the most challenged, raising hopes and questions in equal measure about the future of healthcare in England.
