The recently published 10 year plan for the NHS2 contained an initiative that has profound implications for both performance management and quality of care. The NHS performance assessment framework (PAF)3 already makes comparative indicator data publicly available, including clinical indicators such as readmission rates and perioperative mortality rates. The annual publication of these performance indicators4 by the NHS is about to be supplemented by a new “traffic light” grading system for NHS organisations. On the basis of a selection of performance measures all organisations will be categorised as “red”, “yellow”, or “green”. This approach is taking the use of league tables to another level.