Setting the targets but missing the point

In 2006, NHS hospitals had 62 performance targets. Their performance on these targets was assessed and published each year. This had a profound effect. Nearly every hospital improved dramatically on each of the targets overnight. Before the targets were introduced, for example, 23 % of patients spent longer than four hours in A&E, two years later this figure was down to just 5 %. This dramatic improvement was seen across the board.

This speaks volumes to the performance-driven culture of the NHS. In hospitals, what's measured is what matters. And this extends to the UK public sector as a whole. With no market indicators, public bodies and their employees define success based on targets set by the central government.

But something strange happened when the government set sustainability targets in areas such as recycling, waste, water, renewable energy, and energy efficiency for its departments. Rather than slam dunking each of the targets as usual, departments have failed to tackle any target with consistency or vigor. While the star ratings used for NHS bodies improved performance across the board, star ratings for sustainability have left a considerable portion of departments with just one star and little change in performance. Even more worrying is the regression in some of the areas. Good progress in energy from renewable, for example, at 28.3% in 2007 is now only 22 %.

So something strange is going on here. The characteristically target-driven public sector appears now to have other priorities. What's going on?

Firstly, sustainability just might be a harder target than usual. There is some merit to this; with a growing estate, reducing net arisings is indeed difficult. But this couldn't be the whole story for the simple and unfortunate reason that government departments, faced with missing targets, are typically inclined to 'cook the books' or game the system to show that the target has been met. This is a rampant and well-documented practice in government. Hospitals, for example, asked to reduce A & E waiting times, would simply have patients wait in the ambulances (for hours) in order to meet the target. In the case of sustainability, departments simply don't find it necessary to cook the books.

This leads to the second factor, which is that central government simply doesn't care about sustainability targets. Failing to meet NHS performance targets often means changes in administration but obviously this doesn't apply here. Without any political mandate behind the targets they can be, and obviously are, ignored. In this case, the central government is using targets to make a statement and look good to the public, while failing to provide any motivation for their goals.

This faade will only become more apparent as government performance continues to stagnate. The lack of progress on sustainability performance indicators is bad, the regression on some is intolerable, but we can't blame the government departments. We need to call out those people setting the targets centrally.

They're setting the targets but missing the point.