St Andrew's Healthcare has pioneered the use of Health of the Nation Outcome Scales (HoNOS) data to power key performance indicators demonstrating change on global and risk-related outcome among a diverse group of patients with mental disorders, neurodevelopmental and learning disabilities, and acquired brain injury. Performance indicators based on routinely collected outcomes data for 2008 and 2009 were calculated for six specialist services (at Northampton men's, women's, adolescent, older adults secure services and our brain injury rehabilitation unit; and in our low secure adult service in Essex) to demonstrate change. Mean 90-day change rates of +0.64% and +0.52% on the risk outcomes indicator, and of +0.78% and +0.66% on global outcomes measures were demonstrated for 2008 and 2009 respectively. Differentials in change rates between services with highly specialised service-user needs reflected clinical realities. St Andrew's Healthcare has now published six years of performance data demonstrating continuous positive change for our patient groups. These indicators should be viewed as valid and stable and should be more widely adopted.