Targets. They hurt, but (sometimes) they work

A u-turn on NHS waiting times shows the Conservatives have realised how hard it is getting things do

The Guardian reports today that the government has been forced to re-instate something resembling the old target for waiting times. Labour imposed a limit of 18 weeks as the maximum amount a patient should have to wait for an operation. The target was scrapped by Health Secretary Andrew Lansley since it represented an "arbitrary", "top down" bureaucratic approach. This, it was imagined, would be unnecessary because reforms would deliver a newly efficient, ultra-responsive market in health care in which patients' needs would be accommodated by the profusion of competing providers. Clearly, things aren't quite working out that way and a modified version of the 18-week limit will be back in place in the New Year.

The Conservatives in opposition were routinely scathing about targets, which, they argued, skewed outcomes by creating perverse incentives. Plainly this was true some of the time. A target of holding down waiting times in accident and emergency wards, for example, sometimes resulted in patients simply being sent away. And there is no doubt that New Labour came to rely too much on targets across Whitehall as a way to force the civil service to deliver what had been pledged by ministers, which was demoralising for the departments and skewed priorities.

But the reason Labour used targets so freely was because there weren't many other ways to make civil servants focus relentlessly on the government's priorities. They worked.

Many Conservatives in opposition persuaded themselves that Labour simply liked being bossy and controlling because that is what statist lefties do. I remember a conversation with a shadow minister (now a minister) before the election who told me with pride how he had deliberately not written any performance measures into a policy green paper because the Tory way was to create incentives and trust people, not to regulate them with targets. And what if the incentives aren't taken up? I asked. "We'll come up with better incentives."

In the early days of the coalition, a number of senior civil servants reported being told by incoming Tory ministers that the kind of measurements and targets that had previously been used to check performance in the system were no longer required because "that's not how we do things." It was an ideological shibboleth.

18 months into government, ministers are now finding - as was predictable - that without targets and specific performance measures, policies and pledges get lost in the system. Crudely speaking, unless someone is leaning down hard from above asking hard questions about why targets aren't met, nothing seems to happen. The appalling word that Downing Street under Tony Blair used to use for this stuff was "deliverology" - the art (or science, depending on your point of view) of actually getting things done in government.

It is becoming increasingly clear that David Cameron, with his predilection for presidential floating above the fray, has neglected this area. Steve Hilton, his policy chief, is constantly exercised by it but he tends to think the problem lies in all forms of bureaucracy and civil servants not being dynamic, professional or generally enough like private sector entrepreneurs feverishly making change happen like a bunch of Berkeley graduates building a start-up social enterprise in a San Francisco garage. Maybe it would be nice if Whitehall mandarins were a bit more like that. But it isn't going to happen soon. So for the time being, it looks like it has to be targets.

Of course, this government isn't entirely hostile to the idea of setting arbitrary benchmarks for performance. It is committed to bringing annual net migration down to below 100,000. When the public get really cross about something, out come the targets. That tells us something about the u-turn on operation waiting times. Clearly ministers are very nervous about the growing backlash against changes in the NHS.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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Theresa May's Article 50 letter fires the Brexit starting gun

But as well as handing over a letter, Theresa May hands over control of the process. 

So the starting gun will be fired, and the Brexit process will begin. The delivery of the letter from Theresa May to Donald Tusk is a highly symbolic moment. It is also, crucially, the moment when the Prime Minister loses control of the process.

Perhaps the most striking thing about the Brexit process to date has been the remarkable degree of control exercised over it by Downing Street. Brexit means Brexit, declared the Prime Minister, and since that day it has been her who has defined what precisely it does mean. After a quarter century of bitter division over Europe, culminating in a referendum where the Parliamentary party was split down the middle, she has managed to unite the overwhelming majority of the Conservative party for a “hard Brexit” that very few claimed to support a year ago.  As an impotent opposition and ineffective Tory opponents watched on, she has made it clear from the first that Britain will leave the single market and, almost certainly, the customs union. Rumours from Whitehall suggest that, whatever the concerns or doubts of line departments, these have been ignored or over-ruled.

Now, however, the Prime Minister has lost control of the process. Inevitably, given the relative strength of the parties’ negotiating positions, both the agenda and outcome of the talks will be determined largely by our European partners. It is of course true that they have an interest in preserving trade with us, as do we with them; nor do they have any interest, either economic or political, in “punishing” us for the sake of it. That being said, our interests and theirs are far from aligned. They have other priorities. Not allowing cherry picking among EU rules is one. Ensuring Britain pays its fair share is another.

And, while it is in neither side’s interest for the talks to collapse, we have considerably more to lose. May’s claim that “no deal is better than a bad deal” may play well with the Daily Express, but is has not gone down well with UK business. As the economics professor Jonathan Portes sets out here, the consequences of “no deal” would go far beyond the mere imposition of tariffs; the economic impacts would be significant for other EU countries, and very  severe indeed for the UK.  There are increasing signs that ministers are, belatedly, appreciating the risks, and are anxious to avoid such an outcome.

So both sides want a deal – and the UK, at least, needs one. But several hurdles stand in the way. In the first place, there is the vexed question of money. Britain, as our partners are concerned, has outstanding liabilities that must be paid. The British government may accept some of these, but is sure to quibble about the sums. Discussions of money are never easy in the EU, and the task of figuring out what a net contributor to the budget might owe at a time when discussions over the new 5 year funding programme are about to start will be no exception.  Nevertheless, if it were simply left to the civil servants, no doubt an acceptable compromise would be reached. The bigger  issue  is whether Mrs May  is prepared to take on some of her own backbenchers – and, more importantly, sections of the UK press – to sell a deal that will inevitably mean that the UK writes a sizeable cheque.

Second, there is the question of how to ensure the "frictionless" trade of which the Prime Minister has spoken. This makes eminent sense on one level – why make trade more difficult with the partner that buys 44 per cent of our exports? On another, though, it is hard to see how she can deliver.

I for one simply lack the imagination to see how we can be sufficiently out of the customs union to allow us to sign our own trade deals, while sufficiently in it to avoid customs checks and tariffs. For another, it is difficult to foresee conditions under which the EU would allow us to enjoy any of the benefits of the single market – whereby states accept each other’s rules and standards – without the oversight provided by the European Court of Justice.

And finally, since all parties now seem to accept that the prospects of concluding an “ambitious and comprensive” trade deal by March 2019 are vanishingly, there is the question of what happens then. The government has talked about an “implementation phase”; but how do you have an “implementation phase” when you do not know exactly what you are trying to implement?

It could just be me. I may simply not have fathomed the subtle devices that might allow these circles to be squared. But it does seem clear to me that doing so would be far from straightforward.

And then, of course, whatever is negotiated needs to be approved. Forget for a moment the continent, where there has probably never been a worse time to try to get a free trade deal approved by 27 European parliaments. The Prime Minister will almost certainly have parliamentary problems here in the UK.

The Labour party has adopted a position whereby they will vote against any deal that does not provide the “exact same benefits” as we currently have as members of the single market and customs union,” to quote Keir Starmer. If the other member states are to be believed, the full benefits of membership are, and will be, only available to members, so this is will simply not be the case.

Labour, then, will probably end up voting against the bill. What Tories opposed to either Brexit or to leaving the single market might then do is anyone’s guess. It may be that, by autumn of 2018, they feel sufficiently empowered  - either because of a shift in public opinion, or because of indications of falling economic confidence, or, conceivably, because of declining faith in the Prime Minster – to make common cause with the opposition.

Under such circumstances, May might face the real possibility of defeat in Parliament. Which in turn poses the question as to why she would she risk putting a deal that might be rejected to a vote?

It seems to me that she would have very little incentive to do so. If she cannot get the kind of deal that seems, on the surface, impossible to get anyway, surely better, from her point of view to simply walk away? Blaming the Europeans for failure would be all to easy. And holding a snap election on a patriotic ticket and opposed by the current Labour party would guarantee a healthy majority.

Two years is a long time in politics. And much that is unexpected will doubtless transpire during the negotiations to come. Do not, however, discount the possibility that it might all go wrong. 

Anand Menon is director of The UK in a Changing Europe and professor of European politics and foreign affairs at King's College London.