NHS League Tables 2025: Trust Rankings Explained

For years, patients and staff alike wondered why the performance of NHS trusts was hidden behind internal classifications, until September 2025 when NHS England opened the doors by publishing public league tables for the first time in two decades. This guide explains how the 2025 NHS league tables work, what they measure, and where to find the rankings.

Number of NHS trusts covered: All acute, ambulance, mental health, and community trusts in England ·
First publication date: 9 September 2025 ·
Governing framework: NHS Oversight Framework ·
Update frequency: Quarterly ·
Latest published quarter (as of early 2026): Q3 2025/26

Six key facts from the data, one pattern: the 2025 tables mark a shift from opaque internal segmentation to public, comparative rankings.

What are the NHS league tables 2025?

Overview of the 2025 return to public trust rankings

• For the first time in more than 20 years, NHS England published a set of league tables ranking all NHS trusts in England on 9 September 2025 (TNA).
• The tables cover acute hospitals, community services, mental health trusts, and ambulance providers (TNA).
• This move brings performance comparison into the open after two decades of internal segmentation without public ranking (NHS England).

Key differences from the previous segmentation model

• Before 2025, trusts were classified into segments using the NHS Oversight Framework, but the results were not published as a comparative league table (TNA).
• Now the aggregated metric rankings (AMR) allow patients, commissioners, and the public to see exactly how each trust performs relative to its peers (NHS England).
• The tables also publish individual metric rankings (e.g., 18-week elective care standard) alongside the overall ranking (NHS England).

The pattern is clear: transparency shifts accountability from internal governance to public scrutiny.

How are NHS trusts ranked in the 2025 league tables?

The NHS Oversight Framework metrics

• Trusts are measured against around 30 indicators across five domains: access, safety, workforce, finance, and patient/staff survey measures (TNA).
• Each indicator is scored from 1 (best) to 4 (worst) (TNA).
• An average delivery score is then calculated from the scored measures (TNA).

Aggregated metric rankings (AMR) explained

• NHS England defines aggregated metric rankings as the average of all Oversight Framework metric scores, producing an overall ranked order of trusts (NHS England).
• This AMR forms the backbone of the league table — a trust’s position tells you how it performs across all metrics combined (NHS England).
• Individual metric rankings (e.g., cancer waiting times) are also published side by side (NHS England).

Quarterly segmentation and scoring

• After scoring, trusts are placed into performance segments — from Segment 1 (best performing) through Segment 4 (most challenged), with a possible Segment 5 for Recovery Support (TNA).
• A trust in financial deficit cannot be placed higher than Segment 3 (TNA).
• NHS England warns that confidence intervals should be checked when reviewing overall rankings, because metrics cover different time periods and frequencies (NHS England).

The implication for patients is that the overall score masks significant variation across metrics.

How does the NHS rank structure work?

Understanding the NHS Oversight Framework segmentation

The NHS Oversight Framework automatically assigns trusts to segments 1–4 based on their combined performance across around 30 metrics. Detailed scoring is explained in the section on Quarterly segmentation and scoring above.

Four-segment model: acute, ambulance, mental health, community

• Segment 1: Best performing trusts — minimal oversight.
• Segment 2: Strong overall trusts — standard oversight.
• Segment 3: Weaker trusts requiring support — tailored improvement plan.
• Segment 4: Most challenged trusts — intensive intervention, possible Recovery Support.

This model applies equally to all four trust categories: acute, ambulance, mental health, and community.

Which are the best and worst NHS hospitals in the UK?

Top-performing NHS trusts in 2025

• NHS England publishes the full list of segment placements on its segmentation dashboard (NHS England).
• Trusts in Segment 1 represent the highest performers across all metrics (TNA).
• Individual trusts, such as Imperial College Healthcare NHS Trust, also publish their own Oversight Framework rankings, giving a more granular view (Imperial College Healthcare NHS Trust).

Trusts with the most significant challenges

• The worst-performing trusts fall into Segments 4 and 5, which require urgent support or recovery intervention (TNA).
• Being placed in a lower segment does not automatically mean poor patient care — a trust could score badly on finance or workforce metrics while maintaining good clinical outcomes (NHS England).

The table below maps the four segments to their characteristics — a quick way to understand what a trust’s segment label really means.

The catch: a trust’s segment label is a summary, not a verdict on individual departments.

Where can I find the official NHS league table data?

NHS England’s segmentation and league tables webpage

Official data is available at the NHS England segmentation and league tables page: NHS England (segmentation page). The dashboard includes downloadable files and segmentation results.

Acute trust league table long-read (Q3 2025/26)

The acute trust league table for Q3 2025/26 is published as a long-read page with aggregated metric rankings and downloadable data: NHS England (official guidance).

Individual trust performance pages

Some trusts self-publish their Oversight Framework rankings. For example, Imperial College Healthcare NHS Trust provides its own detailed ranking: Imperial College Healthcare NHS Trust (trust self-publication).

For patients in England, the choice is now clearer: use the league tables to compare trusts on specific metrics like waiting times, but factor in individual trust reports and discuss options with your GP. For NHS trust leaders, the tables are a double-edged sword — increased accountability alongside the risk of narrow performance gaming. The most honest reading of the 2025 data is that transparency is a start, not a finish. For the average patient, the implication is simple: look at individual metric rankings, not just the overall segment, and ask your trust how they stack up on the measures that matter most to you.