Acute trust league tables

The Department of Health and Social Care and NHS England have today (9th September 2025) published a new system of league table for the NHS in England.

From next year, a new wave of Foundation Trusts will be introduced, giving the best-performing trusts more freedom to shape services around local needs, whilst trusts facing the greatest challenges will receive enhanced support to drive improvement.

The rankings are calculated as follows:

• Each trust is scored against metrics in the National Oversight Framework (NOF), which reflect the delivery of NHS priorities, including performance against targets like reducing wait times for electives and A&E, and improving ambulance response times.
• Each trust is ranked by average metric score and assigned to one of the four equal ‘segments’ (performance categories) informing the improvement support each receives from NHS England.
• Reflecting the need for the NHS to recover financially, any trust in deficit can be no higher than segment 3, and those initially placed in segments 1 or 2 will have their segment adjusted regardless of wider performance.
• Trusts are then ranked within their category (acute, non-acute, or ambulance) based first on this adjusted segment classification and then by their average metric scores to determine their league table position.
• NHS leaders will receive extra pay incentives to go into challenged trusts and turn them around. Where trusts are persistently failing, senior managers could see their pay docked – this forms part of broader work to improve how to support and strengthen management and leadership across the NHS.

Patient feedback will also play a central role in how trusts are ranked, giving people a stronger voice in shaping their care.

Further details

The league tables have two distinct ranking types: aggregated metric rankings (AMR) and individual metric rankings (IMR).

IMR league tables focus on single specific metrics and can be used to compare performance of organisations across the country – for example, to understand how each trust performs against the 18-week elective care standard. IMR league tables are primarily designed to give patients understanding of how performance varies across the country, to empower them to make more informed decisions about their care.

AMR league tables provide an overall view of each organisation compared to other trusts of the same type. The AMR league table uses the average of all NHS Oversight Framework metric scores to provide a ranked order of trusts. The AMR is designed to support people to understand the overall position of the organisation in relation to its peers and to understand actions needed to progress towards improved segmentation. It is also used as part of local NHS accountability: for example, supporting health and wellbeing boards and local authorities to understand the relative overall performance of trusts in their locality.

The AMR acute trust league table is for small acute, medium acute, large acute, teaching acute, specialist acute, multi-service acute trusts.

Trusts are ranked within their league table using two things:

1. NHS oversight framework segment

• Trusts are grouped by their segment number (1 to 4)
• Segment 1 trusts are ranked highest, followed by segment 2, then 3, and finally 4
• So, all segment 1 trusts will always be above segment 2 trusts in the table

2. Average metric score

• Inside each segment group, trusts are then ranked by their average metric score
• A lower score means a better ranking
• The top ranked trusts will be the segment one trust with the lowest average metric score, the lowest ranked trust will be the segment four trust with the highest average metric score

Some factors to keep in mind when using the league tables to compare one organisation against another.

• Types of trust – The table shows each trust’s organisation type along with its segment, score, and rank to help compare organisations of similar size, function or complexity. The dashboard also has a map feature to facilitate direct comparison of  similar types of trusts.
• Lag times – Data is collected and published at different times (monthly, quarterly, or yearly), there can be delays depending on how complex the data is. This means that when metrics are combined into one ranking, they are based on different timeframes, which makes direct comparisons between them less reliable.
• Understanding confidence intervals and performance volatility – League tables use average scores to make performance easier to compare. To give a fuller picture, the dashboard also shows individual metric scores and RAG ratings (Red, Amber, Green). This helps users see both the overall average and how performance varies across different measures. The dashboard includes a statistics tab with details on confidence intervals to give a range where the score or rank is likely to fall, with 95% certainty, based on the mixture of metrics included within the framework for each organisation. Trusts that perform consistently across different areas are likely to have narrower intervals (more certainty) whilst trusts with more varied performance, very high in some areas and very low in others, have wider intervals (less certainty).

The acute trust league table can be viewed here.

Further details can be viewed here.