The Department of Health has decided to introduce an extra category in the traffic-lighting system as speculation mounts about how it can avoid high-profile managers being associated with trusts that are seen to be failing.

NHS chief executive Nigel Crisp last week confirmed that 'a fourth category will be introduced for organisations we are worried about, but who are not red' and the traffic lights themselves will not now be published until September.

The number of trusts expected to be given a red light may not even reach double figures now moves are being made to shift some into the 'not-so-red' group.

HSJ sources have indicated that some of those originally expected to be red were organisations headed by prominent figures, recognised by government for their role in developing services.

Having a fourth category could distance these trusts from the 'failure' label and avoid political embarrassment. One source said the DoH was 'in danger scoring an own goal unless they recognised the traffic lights were not going to work'.

Another said the government was 'frantically trying to come up with something to prevent hideous embarrassments'.

The DoH is also back-pedalling on the allocation of green and yellow lights and has pledged to use 'a wider basket of indicators' in addition to the core national targets used to identify red organisations.

These indicators, expected to approximate those set out in the NHS performance assessment framework, are likely to cover areas such as early detection of cancer, generic prescribing and re-admission rates, as well as waiting times and delayed discharges.

An element of 'judgement' will also be installed, though at this stage it is unclear what that means or who will have any veto.

But even more tweaking of the system is also on the cards, and it seems the allocation of traffic lights this autumn will be a oneoff using these methods, with moves next year to a 'balanced scorecard approach'.

NHS Confederation policy director and member of the performance taskforce Nigel Edwards said: 'We are absolutely delighted the government is moving to this balanced scorecard method. We have been pressing them for some time, saying traffic lights on their own will not achieve the rounded view that is needed.

'Traffic lights are a starting point, but It is becoming clear they're not very helpful in providing organisations with information about themselves and how their performance is changing.'

The details of what makes up the balanced scorecard have yet to be worked out.