| NHS: The return of "targets and terror"? 08:05 - Nov 13 with 1541 views | AnotherJohn |
Wes Streeting is in the news today with his statements about hospital league tables and sackings for managers who fail to get waiting lists down. Older forum members may remember that this is similar to the policies introduced after 2000 when Labour was last in power - the period of so-called "targets and terror."
https://www.lse.ac.uk/Research/research-impact-case-studies/improving-public-ser
https://www.bristol.ac.uk/cmpo/audio/targets.html
Will it work this time around you may ask? Well, it did at one level because Labour did get waiting times down. However, some would say that this had more to do with the major increase in NHS funding at that time than with cracking the whip. The downsides of targets and terror included gaming of the system by manipulating performance data, a negative impact on management morale, and focusing on certain objectives at the expense of others. It was said by Bevan and Hood that "what's measured is what matters", leading, for example, to complaints from doctors that non-serious cases about to exceed waiting times targets were prioritised over more serious cases who hadn't waited as long. We shall have to see how it works out this time.
There is always a certain resonance when politicians say the NHS needs reform - and especially given how things are now. The trouble is that the NHS since around the mid-1970s has been locked into a kind of Maoist permanent revolution. Some commentators were arguing that what was needed was a period of stability and consolidation, but it turned out that the most recent lull in reform coincided with a steeply rising and ageing population, constrained budgets, a crisis in social care and a pandemic. [Post edited 13 Nov 8:15]
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| NHS: The return of "targets and terror"? on 20:21 - Nov 16 with 342 views | majorraglan |
Most companies and organisations “have” targets in one shape or another, wherever I’ve worked in whether that’s in the private or public sectors the organisation has had targets. The trick though is to make them meaningful, to make people directly accountable and to make sure the big big bosses are also accountable and manipulation of the figures will be considered to be gross misconduct and sackable conduct.
There’s an old saying… “what gets measured gets done” [Post edited 16 Nov 20:23]
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| NHS: The return of "targets and terror"? on 10:54 - Nov 17 with 270 views | controversial_jack |
| NHS: The return of "targets and terror"? on 20:21 - Nov 16 by majorraglan |
Most companies and organisations “have” targets in one shape or another, wherever I’ve worked in whether that’s in the private or public sectors the organisation has had targets. The trick though is to make them meaningful, to make people directly accountable and to make sure the big big bosses are also accountable and manipulation of the figures will be considered to be gross misconduct and sackable conduct.
There’s an old saying… “what gets measured gets done” [Post edited 16 Nov 20:23]
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Performance related pay was never a good thing in my opinion. Very divisive. It often had nothing to do with performance, rather an opportunity to reward those whose faces fitted - the noshers and networkers | | | |
| NHS: The return of "targets and terror"? on 16:53 - Nov 17 with 226 views | AnotherJohn |
| NHS: The return of "targets and terror"? on 20:21 - Nov 16 by majorraglan |
Most companies and organisations “have” targets in one shape or another, wherever I’ve worked in whether that’s in the private or public sectors the organisation has had targets. The trick though is to make them meaningful, to make people directly accountable and to make sure the big big bosses are also accountable and manipulation of the figures will be considered to be gross misconduct and sackable conduct.
There’s an old saying… “what gets measured gets done” [Post edited 16 Nov 20:23]
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Your old saying is similar to the phrase that academics writing about the NHS suggested: "What's measured is what matters". The question that the latter raised was what happens to those outcomes that are not measured? In a complex organisation like the NHS you cannot practically set targets or construct performance indicators for everything, so some things will be foregrounded and others receive less attention. The hospital league tables will necessarily be constructed to take account of quite a limited set of indicators, and - as in the past - there will be controversy about how fair they are to all hospitals. | | | |
| NHS: The return of "targets and terror"? on 17:33 - Nov 17 with 208 views | majorraglan |
| NHS: The return of "targets and terror"? on 16:53 - Nov 17 by AnotherJohn |
Your old saying is similar to the phrase that academics writing about the NHS suggested: "What's measured is what matters". The question that the latter raised was what happens to those outcomes that are not measured? In a complex organisation like the NHS you cannot practically set targets or construct performance indicators for everything, so some things will be foregrounded and others receive less attention. The hospital league tables will necessarily be constructed to take account of quite a limited set of indicators, and - as in the past - there will be controversy about how fair they are to all hospitals. |
With the advent of tools like Power BI having detailed and robust data is certainly possible and will provide much more information than before.
HMIC have data which Nablus effective comparisons between police forces and there’s no reason why we can’t have that in the NHS. It doesn’t need to be hospital level, in Wales it could be Health Board level as there only 7 of them. I’d have no issue with some areas receiving less attention, those areas could be subject to reduced scrutiny or thematic inspections and comparisons. The executives and senior managers would be made responsible for delivery, if there are issues in relation to reaching a target then the barriers need to be discussed in an adult way and steps identified to overcome the issues. It wont take Einstein to sort this out, just people who know what they’re doing. | | | |
| NHS: The return of "targets and terror"? on 20:54 - Nov 17 with 165 views | AnotherJohn |
| NHS: The return of "targets and terror"? on 17:33 - Nov 17 by majorraglan |
With the advent of tools like Power BI having detailed and robust data is certainly possible and will provide much more information than before.
HMIC have data which Nablus effective comparisons between police forces and there’s no reason why we can’t have that in the NHS. It doesn’t need to be hospital level, in Wales it could be Health Board level as there only 7 of them. I’d have no issue with some areas receiving less attention, those areas could be subject to reduced scrutiny or thematic inspections and comparisons. The executives and senior managers would be made responsible for delivery, if there are issues in relation to reaching a target then the barriers need to be discussed in an adult way and steps identified to overcome the issues. It wont take Einstein to sort this out, just people who know what they’re doing. |
Well, please remember that our current discussion is about Wes Streeting's proposal to return to using hospital league tables. with negative consequences for poor hospital managers. so hospitals would appear to be the unit for comparison in NHS England. League tables have traditionally been constructed on the basis of quite a small set of performance indicators. What I did not say before is that the proposals are about England, and it will be up to the devolved administrations whether to follow suit. One might suppose that Welsh Labour would follow the UK government, but actually that did not happen after devolution, when the Milburn reforms did not go down well, and Rhodri Morgan was talking about "clear red water" between Westminster and Cardiff, As there is still a purchaser/provider split in England (where hospitals are constituted as NHS Trusts separate from Integrated Care Boards), but not in Wales, it might indeed make more sense to compare Welsh health boards (which oversee hospitals) rather than the hospitals themselves. No doubt improved IT would help the recording and monitoring of a wide range of targets, but to me the problem lies in bringing all these together, weighting their relative importance, and making some meaningful overall assessment. Healthcare Inspectorate Wales already collects data on a complicated set of health and care quality standards comprising "high-level" standards in six quality domains affected by six "quality enablers", albeit without putting much emphasis on "terror" for poor performers. I'm not sure that better IT really helps in deciding what the aggregated data that is produced means. In recent times, tools like the "balanced scorecard", combining various PIs, have been used to compare performance of health boards. but this has always been controversial. I don't know if any forum members are closer to this than I am, and know how things are working at present. | | | |
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