On Thursday, the govt will publish its Plan for Change. This will include key 'milestones' for each of the govt's five missions. Targets such as these have been used extensively by previous govts trying to improve public service performance. But how effective are targets? A short🧵on the evidence: - ThreadSky

njdavies.bsky.social • 116 days ago

On Thursday, the govt will publish its Plan for Change. This will include key 'milestones' for each of the govt's five missions. Targets such as these have been used extensively by previous govts trying to improve public service performance. But how effective are targets?

A short🧵on the evidence:

Comments

wiggett-ie.bsky.social•116 days ago

Targets will always have unanticipated consequences, because they skew effort towards a particular objective. Those consequences may be undesired and dangerous.

njdavies.bsky.social•116 days ago

Targets are very effective at improving what is targeted. The more aggressive use of targets in England under Blair resulted in better waiting times performance and school attainment on the targeted measures than in other parts of the UK

simonparker.bsky.social•116 days ago

Couple of important nuances if I may. First, Blair-era targets were to some extent about directing new money to government priorities. Today's targets will have to redirect existing resources to something else. This exacerbates the problems you've identified.

simonparker.bsky.social•116 days ago

Second, while some of the Blair/Brown targets were hit, quite a lot weren't and no one really cared. It was the focus on a very select number of metrics that drove the change you describe.

njdavies.bsky.social•116 days ago

Improvements in targeted metrics are partly the result of gaming. e.g. hospitals data was manipulated, patients left waiting in ambulances, and appointments that didnt contribute towards meeting a target were cancelled

Targets also encouraged excessive funding of targeted areas at expense of others

njdavies.bsky.social•116 days ago

Targets are more effective at raising minimum standards (scrapping school league tables in Wales had no effect on top 1/4 of schools, only bottom 3/4s)

Conversely, targets can create a culture of compliance that discourages innovation and prevents adequate services from excelling

njdavies.bsky.social•116 days ago

There are 3 ways targets can improve services:
1) signal political priorities and focus activity on delivering specific objectives
2) increase accountability between centre of govt, the front line and the public
3) incentivise deeper analysis of the causes of performance problems

njdavies.bsky.social•116 days ago

There are 3 ways targets can damage services:
1) incentivise staff to prioritise easy wins, ignore important issues and manipulate data
2) reduce the ability of front-line staff to use their professional judgment
3) overwhelm staff with requirements to collect and input data

njdavies.bsky.social•116 days ago

Targets are most likely to succeed where services are performing poorly, those subject to a target have control over whether it is met, public and staff expectations are poorly aligned, and where it's possible to design a target that is closely aligned with the desired outcome

aloner.bsky.social•116 days ago

📌

robyeldham.bsky.social•116 days ago

I was a senior civil servant at the end of the last period of Labour administration. PSA targets worked to make government departments and agencies collaborate on interconnected issues in my experience.

njdavies.bsky.social•116 days ago

Yes, I think the cross-departmental, outcome focussed final iteration of PSAs were the best attempt at this there’s been in the UK

iainj.bsky.social•114 days ago

This thread excellent starting point for thinking critically about ‘missions’ and ‘targets’. But is missing from Govt? Early Years ? ✅

Why no mission to increase participation of adults in all forms of learning? Measure improvements in indiv
health & health of communities- not just skills for work

boredaardvark.bsky.social•116 days ago

One way to reduce outpatient waiting lists is opt in. Choosing an appointment they can make, reduces DNAs, also reduced when people wait less time. But it also loses some of the most vulnerable patients who might come to a sent appointment but can’t/won’t navigate the bookings system.

peashen.bsky.social•116 days ago

This happens in Lothian in Scotland given an appt date but you can call up to change it to a more suitable one
Works well

stuarthoddinott.bsky.social•116 days ago

This already exists! It's called patient initiated follow up and it hasn't delivered an enormous reduction in outpatient appointments

https://www.england.nhs.uk/outpatient-transformation-programme/patient-initiated-follow-up-giving-patients-greater-control-over-their-hospital-follow-up-care/

boredaardvark.bsky.social•116 days ago

This is for initial appointments and is more about reducing DNAs and waiting lists than actual outpatient appointments. DNAs tend to be higher in certain areas. We can also see patients that need it sooner for follow up. If anything it increases no of appointments.

evilceldrud.bsky.social•116 days ago

What happened to continual improvement? Isn’t that a very different philosophy to external inspection and targets? Have we really tried cooperation and whole system person centred life and community maps and strategies?

calenhad-social.bsky.social•116 days ago

If the plan for change doesn't include rectifying Fuxit I wouldn't even wipe my arse with it.

manteg124.bsky.social•116 days ago

Not

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