04 June 2009

Mickey Mouse micro-targets

It's important, I think, that we have some way of monitoring the performance of bodies charged with solving our social and environmental problems. In our large, complex societies, that means we have to use numerical measures and indicators. They all have their weaknesses, but alternatives are, almost by definition, subjective and even less reliable. The Social Policy Bond approach would target broad goals that are meaningful to ordinary people. Its goals would, as far as possible, be inextricably correlated to social or environmental wellbeing. Unfortunately, the use of numerical indicators for targeting purposes is acquiring a bad reputation. Current targets are unsystematic, too narrow, and almost totally uncorrelated with the wellbeing of ordinary people.

Take the well-meaning goal of reducing the waiting time for patients entering the Accident and Emergency wards of UK hospitals to less than four hours. James Bartholomew explains what happens in practice:
1. The ambulance bringing the patient to the hospital is kept waiting outside. The hospital simply declines to accept the patient. This means that the starting time of the four hour wait is delayed and the hospital can claim it is meeting the target.

2. The hospital refuses to accept any emergency patients for a while. The patient has to be transported to a different hospital. This enables the first hospital rightly to claim that patients who get into the hospital are not kept waiting for more than four hours.

Why are the hospitals so keen to meet the target? Because the hospitals receive less money from the government if they fail to meet it.

Who or what suffers? Of course the patient suffers from being kept waiting for emergency treatment for more than four hours. In the second case, the patient may be carried to a hospital that is much further away, delaying treatment. Also people suffer who need an ambulance but cannot get one because ambulances are being kept waiting outside hospitals or taking journeys to hospitals far away. But this suffering is not a direct result of the target. It is a result of inadequate emergency provision in NHS [National Health Service] hospitals. What suffers directly as a result of the target and the cheating on the target is the truth and public awareness of the truth. That, of course, suits the government well. The truth that is kept secret from the voters is the extent to which the massive increase in spending on medical services in Britain has been wasted. We simply do not know the extent because NHS statistics are lies.

No comments: