Government targets are proliferating in social care. But they undermine local democracy, demotivate managers and distort services, reports Terry Philpot.
Governments abhor a vacuum and since the mid-1970s, when Sir Keith Joseph and Conservative sceptics of government spending detonated the belief that big budgets are best, Whitehall has looked for a more realistic evidence-based tool to judge whether local authorities and the health service are coming up with the goods.
They alighted on judgement by output. Outputs, not inputs, would be the measure. But, then, how to measure outputs, let alone outcomes?
In the early years of John Major's government, performance indicators - if not by that name - came into being. They started to creep into public life under the guise of the Citizen's Charter. But it was really with Tony Blair's first administration and its modernisation programme that the tentacles of indicators started to stretch into almost every corner of public service endeavour.
They have proliferated at such a pace that no one seems to know how many there actually are. There are said to be 600 applied to local government and 300 to 400 are alleged to keep health service managers at their desks. So many and so complex are they that Professor Tony Travers of the London School of Economics has said that the "target regime" is now almost impossible to follow - even experts find it difficult to understand what they are and whether they are being met.
Of course, it was not just Labour's reasonable belief that there had to be sharp turns onwards and upwards for public services. The years of capping, cuts and reorganisations of local government and low standards elsewhere had created a general disillusion and dissatisfaction that required new ways of doing things. There was also the small matter of what was, at best, Labour's ambivalence about local government and, at worst, its distrust of it.
If the politicians suspected that too much of Old Labour still lurked in the town halls, then the civil servants saw renewed hope for getting the unpredictable municipal beast even more firmly within their harness.
And for a government that admits it may not always be right (after all, why else have focus groups?), it is anomalous to accord so much control to civil service target setters. Also indicators shift responsibility from Whitehall to town halls, when sometimes the buck should stop in London SW1.
In its reform of local government political structures alone - elected mayors, half-term elections, suggestions about primaries, cabinet government and so on - civil servants have so far written 700 pages of guidance and regulation. All, no doubt, waiting their transformation into performance indicators to show that democracy flourishes even more vibrantly under New Labour.
Professor John Stewart of Birmingham University is a veteran advocate of local autonomy. But, he says, Labour has taken powers of intervention and control quantitavely further than previous administrations.
Capping, he says, is nothing next to the selectivity of separating the "goodies" from the "baddies" and the doling out of rewards and punishments accordingly. Such powers will increase with the evolution of the specific grant regime into full blown public service agreements, by which revenue support to local authorities is increasingly linked to the delivery of Whitehall-approved targets.
Stewart thinks that performance indicators can have a place if they are used internally by the authority or department to inform debate and argument. But, as it is, the UK is almost alone in Europe in insisting on such a plethora of controls - targets, indicators, inspections, Best Value, audit, leaving aside the chancellor's grip over local authority finance.
And where do targets come from? Who says there should be 600 or 100 or 50? Each justifies itself. They are given the status of a scientific principle even though everyone knows how easily they can be manipulated - for example no one seems to know whether hospital waiting lists have lengthened or shortened.
If it moves, make sure a target guides it. If government sees a problem, it creates an indicator. It's logical when you think about it, or is it? One of the problems with performance indicators is that the targeted get cleverer at the game.
One anonymous senior NHS manager confessed that he knew which three targets of 15 were most important to the Department of Health and he concentrated on them to the neglect of others about which he would not be upbraided. He enjoys a national reputation.
Performance indicators can also have the effect of concentrating managers' minds on achieving them to the disadvantage of services or aspects of services that are not targeted. This could, warns Stewart, be catastrophic.
They can also be inappropriate. For example, take the target that seeks a reduction of children on child protection registers. Even supposing that it is desirable to take off some of the children, doing so does not mean that their problems dissipate overnight. But in Targetland that's another tick on the progress chart.
Then there are the adoption targets. What if social services departments do not think that all of the children needed to meet the desired increase in the number of adoptions should be adopted or even want to be adopted? Why not separate siblings to get the numbers up? Serve the child or serve Richmond House? And it is a fact that between 1996 and 2000 adoptions increased by 43 per cent without the imperative of performance indicators.
What performance indicators do not indicate is quality. The current indicator regime also poses problems of collection, analysis and reporting and eats up expensive management time.
Not to mention the disincentive to working creatively. The regime can also be demotivating. Shaming and blaming may give a higher indicator for ministers' machismo but where is the evidence that it has ever had a positive effect on service users?
Targets have a strangely old-fashioned feel about them, harking back to the heyday of work study. But there's also a more serious and major historical analogy. If targets were the answer, the Soviet Union would be with us still.
As Alec Nove wrote of the USSR: "The planners tried various experiments. They issued instructions that user demand should be met. They modified the bonus systems so that the achievement of purely quantative targets should not be sufficient, that the assortment plan also had to be fulfiled, that costs had to be reduced, that wages not exceeded, and so on. A book could be filled with a list of various expedients designed to encourage enterprises to act in a manner the planners wished, and the troubles to which each of them gave rise."1
Now the secretary of state for transport, regions and local government, Stephen Byers says he foresees a lighter touch for local government, a lessening of bureaucracy and controls. To date there's no sign of that happening.
It was Frank Dobson, when health secretary, who referred to a Berlin Wall needing to be demolished between health and social services. Byers had better look to the lessons of the real Berlin Wall and perhaps make Nove his reading for the Christmas recess.
The unsustainability of an overmanaged economy had as much to do with the Wall crumbling, as did the protests of dissidents. Labour can hardly want the UK's public services to suffer the same fate.
1
Alec Nove, An Economic History of the Soviet Union, Pelican, 1972
