Warning that NHS league tables must not be ‘instruments of blame’

Concerns have been raised that a new system of NHS league tables being rolled out across England today could be used as “instruments of blame”. Trusts have been ranked quarterly against standards in the NHS Oversight Framework, with separate league tables for acute, non-acute and ambulance trusts and dashboards showing detailed performance data. The worst ranking hospital overall was The Queen Elizabeth Hospital in King’s Lynn, Norfolk, while the best was Moorfields Eye Hospital in London. Top-performers will be rewarded with greater autonomy, including the ability to reinvest surplus budgets into frontline improvements such as diagnostic equipment and hospital upgrades. Commenting Matthew Taylor, chief executive of the NHS Confederation, told Digital Health News that league tables must provide “meaningful, accurate information” that empowers patients to make informed choices and enables NHS organisations to share best practice rather than 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. “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,” Taylor said. Hugh Alderwick, director of policy at the Health Foundation, said: “Negative ratings can impact organisational culture, staff morale, and recruitment, which could — perversely — worsen performance further and impact patient care. “There are also big technical issues: ratings are complex to design and risk concealing more than they reveal. “This can reduce trust in the ratings and reduce their value for improving care.” From 2026, a new wave of foundation trusts will be introduced, giving the best-performing trusts more freedom to shape services around local needs – a key pillar of the government’s 10 year health plan. Trusts facing the biggest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-linked pay and the best NHS leaders offered higher pay to take on challenged services and turn them around. Wes Streeting, health secretary, 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 practises with others, taking the best of the NHS to the rest of the NHS.” Trusts will be scored into four performance segments, with the first segment representing the best performing areas and the fourth segment showing the most challenged. Those in the middle segments will be encouraged to learn from top performers to improve on their rankings, so that they can financially benefit from their budget surpluses in the future. Sir Jim Mackey, chief executive of NHS England, said: “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 their hands to make informed decisions on their choice of provider.” See the league tables here. Digital Health Networks leaders react Hayley Grafton, chair of the Chief Nursing Information Officer Advisory Panel: “The launch of NHS league tables is a positive step towards accountability and transparency. However, many of the metrics used to rank trusts are wholly dependent on how data is captured, tracked, and accessed. “From a digital perspective, this may provide insights into the digital and data maturity of trusts. Those with higher digital maturity are likely to be better placed to provide high-quality data that more accurately reflects the care being delivered. “Making this data publicly available could serve as a catalyst for improving, optimising, and embedding digital and data processes. “The key, however, lies with people. Systems must be designed around users, embedding seamlessly into workflows so that data capture becomes part of care delivery rather than an additional burden. Interoperability is also essential in retaining one source of truth while ensuring it is shared where and when it is needed. “While digital maturity is not currently a distinct measure for the ranking, it will be important to see whether digitally mature organisations consistently perform better. If so, digital capability may emerge as a meaningful determinant of success.” Dr Penny Kechagioglou, chair of the Chief Clinical Information Officer Advisory Panel: “The NHS league tables will create a competitive environment that could drive innovation and adoption of digital technologies with the aim of improving productivity and performance. “They could also drive digital transformation through learning from successful organisations and utilising internal skills and capabilities, leading to the standardisation and scaling of good practice. “League tables are an opportunity for NHS trust leaders to think more innovatively when transforming care pathways, focusing on prevention and proactive care, increasing access to good quality care for more people and reducing waiting times to treatment.”