Dr Malcolm Kendrick describes the Quality and Outcomes Framework (QOF) of the UK's National Health Service. It's the usual array of poorly-thought out, meaningless micro-targets that doctors are paid to achieve, but that have nothing to do with health. As Dr Kendrick points out, such (perhaps) well-intentioned, but futile bureaucratic processes impose a formidable opportunity cost on the NHS, to the detriment of doctors and patients. My suggested solution is to apply the Social Policy Bond principle to health; a short description of this application of the bonds is given here; a much longer version here.
We see the same proliferation of Mickey Mouse micro-targets in other policy realms, notably education, and in diversity guidelines or regulations. They spring from the same presumably benign impulse, but they suffer from a similar lack of vision and strategy. They assume that processes that might have served society well in the past will continue to do so into the indefinite future. They do not allow for diverse, adaptive approaches. Yet it takes courage to criticise them, as Dr Kendrick is doing. My experience is that many people grumble about such top-down initiatives but are understandably reluctant to say anything openly. Though Social Policy Bonds aim to inject the market's incentives and efficiences into the solution of our social problems, perhaps their more important contribution - if they ever take off - will be to focus policymakers' attention on outcomes that are meaningful to the people they are supposed to represent.
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