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Will we miss the targets?

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Mark Easton | 17:26 UK time, Tuesday, 20 October 2009

Vote for me! Shinier hospitals, tougher police and better schools. I give you my word... up to a point.

As we head for the election, there will be some big promises from political parties on how public services will be so much better under them. It is always sensible to take such pledges with a pinch of salt, but I do wonder whether, come the next election, we might need a barrel or two of sodium chloride to hand.

Police officers on patrolSchools, hospitals and crime tend to dominate election campaigns and manifestos are crammed with pledges guaranteeing high performance and value for money. Voters care about this stuff - and not just because their taxes pay for it.

In the past, we have had popular promises, for instance, to cut waiting times in A&E departments, to bring more offenders to justice and to ensure that all our youngsters leave primary school able to read and count.

How, though, can politicians keep such promises in future? I ask because both Labour and the Conservatives have made another pledge: to reduce the amount of top-down quality control.

National performance targets backed up by inspection has been the traditional mechanism for trying to ensure that when a minister in Whitehall says "jump", public servants all over the country jump in time.

That mechanism will be dismantled to a greater or lesser degree whichever party controls the Commons next year.

the Conservatives are committed to "cutting right back on all the interference and instructions from central government - the rules and restrictions, the targets and inspections".

a "shift away from that top-down approach" with fewer targets, although they still believe they "play an important role in service delivery".

The problem with central targets (and the inevitable inspection regime you need to enforce them) is that they can have unintended consequences.

Those examples I gave earlier all proved problematic: rather than those in more urgent need in order to hit the waiting-time target; for increasingly petty offences to meet their target; and neglecting other parts of the curriculum to hit theirs. found other examples:

"When government decreed GPs would see all patients within 48 hours of an appointment, GPs simply refused to book appointments more than two days in advance. Similar examples are available in housing benefit payments, and social housing repair times. The results can be tragic. The waiting time targets at one eye hospital were achieved by cancelling and delaying follow鈥恥ps, and as a result at least 25 people became blind because of perfectly preventable problems."

Instead of improving services, the targets made some things worse.

And, it is also argued, the obsession with counting and measuring has led to a bureaucratic horror in which public service becomes drowned by paperwork.

of prison governors allegedly moving inmates about ahead of an inspection is another consequence of a regulatory regime that has come to dominate the daily life and prospects of front-line professionals.

But these systems developed for a reason. Government ministers have to stand up and defend the public services that operate in their name. They are ultimately accountable for performance and value for money.

How does a health secretary ensure that patients get a decent experience at the GP's surgery in Pontefract or Padstow? How does a home secretary make sure officers in Shropshire and Sheffield take neighbourhood policing seriously?

Margaret Thatcher tried to do it with what was called "New Public Management", using market-style mechanisms to encourage efficiency and innovation, but backed up with a system of performance management and executive control to try and make it work.

Labour took it further still as investment in public services rocketed. Tony Blair was determined to ensure that public money didn't spill out of the Treasury only to disappear into a public-service black hole.

Now the government accepts there must be "a new relationship of trust in public service professionals and organisations". The Conservatives echo the rhetoric and would go further.

The risk is that if you take away too much of the regulatory infrastructure, you end up with a very patchy service, a postcode lottery where some people have appalling healthcare or crime control or education because, without the rigour of national targets and inspection, services lack scrutiny and focus and quickly become lazy and inefficient.

For the government, it becomes nigh-on impossible to keep those detailed manifesto promises for everyone.

Advocates of "localism" (and all political parties currently claim to be enthusiasts) suggest that you can measure public-service performance by basic results at the centre and trust local professionals on the ground to work out how to achieve good results. It certainly has its advantages - innovation is more likely to flourish; local problems can get a local solution. But I predict we will see lots of stories about those places that fail to perform and some uncomfortable ministers trying to explain why they are not to blame.

What does seem clear is that Britain has passed the high-water mark on central targets and control. The question for individual voters is whether they believe an era of lighter touch regulation will mean better or worse public services for them.

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