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NHS Trust Rankings 2025: Could Internal Comms Decide Your Place?

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Introduction – The Return of NHS Trust Rankings

In September 2025, the Department of Health and Social Care reintroduced football-style league tables ranking all NHS Trusts in England (The Guardian). This marks a significant shift in performance transparency, echoing the star ratings of the early 2000s. The rankings evaluate clinical outcomes, patient access, financial stewardship, and safety metrics, providing the public with a comparative view of Trust performance and compelling senior leaders to assess how their Trusts are perceived.

Trusts are now classified into four tiers based on overall performance, with implications for funding, oversight, and operational autonomy. Top-tier Trusts may see increased flexibility and investment opportunities, while those in the bottom tier are likely to face targeted interventions and leadership scrutiny (The Times).

For internal communications leaders, these rankings offer a powerful lens through which to understand the strategic importance of employee engagement, clarity of purpose, and cultural alignment. The question is not just “where did we rank?” but “how are we communicating to rise?” For more background, see our blog on Transforming NHS Workplace Communication.

Internal Communications as a Strategic Asset

Too often undervalued, internal communications are essential to:

  • Staff alignment and motivation: Clear messaging ensures that all staff, regardless of role or seniority, understand organisational priorities and how their work contributes.
  • Operational agility: In times of rapid change (e.g. COVID-19, industrial action, policy reform), internal communication channels must deliver timely, accurate information to maintain safety and trust.
  • Staff wellbeing: Studies show that employees who feel well-informed and heard are significantly more engaged and less likely to leave their roles (NHS Staff Survey 2024).

Strategic internal communication empowers organisations to proactively shape culture, prevent misinformation, and foster two-way dialogue. It is not just about what is said, but how, when, and to whom. See our blog on Breaking Down Communication Silos in NHS Trusts for further insights.

Case Study: Royal Papworth Hospital NHS Foundation Trust

As a leading centre for cardiothoracic care, Royal Papworth has long set the benchmark for clinical outcomes. However, their excellence is also built upon a foundation of intentional, strategic internal communication.

The Trusted Delivery Advantage

Royal Papworth uses Trusted Delivery, the only internal email platform designed specifically for NHS communications governance. By using this platform, the Trust ensures that:

  • All communications meet NHS Digital Governance and Information Governance (IG) standards.
  • Messaging is secure, inclusive, and measurable, ensuring full audit trails and readership data.
  • Staff receive content tailored to their role, team, or location, supporting meaningful engagement.

Embedding Culture and Recognition

Royal Papworth actively uses internal communications to:

  • Celebrate achievements, such as successful surgeries, research breakthroughs, and staff awards.
  • Promote psychological safety, where staff feel confident to report concerns or suggest improvements.
  • Encourage cross-team collaboration, particularly important in a specialist environment with complex patient pathways.

By aligning internal communications with its core values, Royal Papworth has fostered a culture where staff feel informed, included, and valued—contributing directly to its position in the 2025 league tables (Royal Papworth Case Study).

Mitigating the Risks of Ranking Systems Through Communication

While league tables provide transparency, they can also:

  • Erode morale in underperforming Trusts
  • Oversimplify systemic challenges like staffing shortages or outdated infrastructure
  • Undermine trust in leadership if not addressed openly

Effective internal communications can counterbalance these risks:

  • Reframing challenges as opportunities for growth and staff-led solutions
  • Explaining context, e.g. how inspection criteria were applied or what’s being done to improve
  • Providing clarity on immediate priorities, support structures, and leadership commitment

By communicating with compassion and transparency, internal comms leaders can help maintain trust during difficult periods (The Guardian). For practical advice, see our article on 10 Proven Strategies for Engaging NHS Internal Comms.

Embedding Culture, Equity and Governance in Messaging

Modern NHS communications must go beyond compliance. They must reflect the NHS values of compassion, inclusion, and transparency.

Policy Compliance

Communications must:

  • Protect personal and sensitive data
  • Adhere to IG Toolkit standards and local DSPT requirements
  • Be traceable, secure, and accessible

Equity and Inclusivity

Trusts must ensure that all staff, including those in non-desk roles (e.g. porters, community nurses, allied health professionals), receive key messages in formats they can access and understand. Trusted Delivery supports segmentation and personalisation, helping communicators reach everyone.

Culture Building

Great internal communications:

  • Reflect and reinforce organisational values
  • Elevate diverse voices and stories
  • Create a sense of unity and purpose

For deeper insights, read our guide on The Power of Storytelling in NHS Internal Communications.

“NewZapp has transformed our internal communications. Before, we were constantly facing issues with delivery and engagement. Now, not only are our open rates up, but staff engagement with surveys and nominations has skyrocketed. The support team has been fantastic, always there when we need them, making sure everything runs smoothly.”
— Laura Favell, Communications Manager, Royal Papworth Hospital NHS Foundation Trust​

Insight and Action for NHS Communications Leaders

This blog is not just a reflection, but a call to strategic action.

Ask yourself:

  • Are our communications aligned with our strategic goals?
  • Do our platforms meet NHS governance standards?
  • Can we measure reach, engagement, and impact?
  • Are we inclusive in language, tone, and accessibility?

Three strategic priorities for 2025/26:

  1. Invest in a governance-aligned communications platform, like Trusted Delivery, to ensure secure, compliant, and effective internal messaging.
  2. Develop a communications strategy that embeds culture, equity, and staff voice into every campaign.
  3. Benchmark internal communications impact as part of wider organisational performance reviews.

Conclusion: Communication as a Performance Lever

As the NHS adapts to new performance frameworks, internal communications must evolve too. Rankings are public, but culture is internal. Trusts that communicate with intention, clarity, and compassion will not only climb the tables, but also create environments where staff thrive and patients benefit.

Trusted Delivery: Designed by the NHS, for the NHS. Supporting secure, inclusive, and strategic communication in every Trust.

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