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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Rarely has it mattered so little if Manchester United won; rarely has it been so special they did

Team's Europa League victory offers chance for sorely needed celebration of a city's spirit.

Carlo Ancelotti, the Bayern Munich manager, memorably once said that football is “the most important of the least important things”, but he was only partly right. While it is absolutely the case that a bunch of people chasing around a field is insignificant, a bunch of people chasing around a field is not really what football is about.

At a football match can you set aside the strictures that govern real life and freely scream, shout and cuddle strangers. Football tracks life with such unfailing omnipresence, garnishing the mundane with regular doses of drama and suspense; football is amazing, and even when it isn’t there’s always the possibility that it’s about to be.

Football bestows primal paroxysms of intense, transcendent ecstasy, shared both with people who mean everything and people who mean nothing. Football carves out time for people it's important to see and delivers people it becomes important to see. Football is a structure with folklore, mythology, language and symbols; being part of football is being part of something big, special, and eternal. Football is the best thing in the world when things go well, and still the best thing in the world when they don’t. There is nothing remotely like it. Nothing.

Football is about community and identity, friends and family; football is about expression and abandon, laughter and song; football is about love and pride. Football is about all the beauty in the world.

And the world is a beautiful place, even though it doesn’t always seem that way – now especially. But in the horror of terror we’ve seen amazing kindness, uplifting unity and awesome dignity which is the absolute point of everything.

In Stockholm last night, 50,000 or so people gathered for a football match, trying to find a way of celebrating all of these things. Around town before the game the atmosphere was not as boisterous as usual, but in the ground the old conviction gradually returned. The PA played Bob Marley’s Three Little Birds, an Ajax staple with lyrics not entirely appropriate: there is plenty about which to worry, and for some every little thing is never going to be alright.

But somehow the sentiment felt right and the Mancunian contingent joined in with gusto, following it up with “We’ll never die,” – a song of defiance born from the ashes of the Munich air disaster and generally aired at the end of games, often when defeat is imminent. Last night it was needed from the outset, though this time its final line – “we’ll keep the red flag flying high, coz Man United will never die" – was not about a football team but a city, a spirit, and a way of life. 

Over the course of the night, every burst of song and even the minute's silence chorused with that theme: “Manchester, Manchester, Manchester”; “Manchester la la la”; “Oh Manchester is wonderful”. Sparse and simple words, layered and complex meanings.

The match itself was a curious affair. Rarely has it mattered so little whether or not United won; rarely has it been so special that they did. Manchester United do not represent or appeal to everyone in Manchester but they epitomise a similar brilliance to Manchester, brilliance which they take to the world. Brilliance like youthfulness, toughness, swagger and zest; brilliance which has been to the fore these last three days, despite it all.

Last night they drew upon their most prosaic aspects, outfighting and outrunning a willing but callow opponent to win the only trophy to have eluded them. They did not make things better, but they did bring happiness and positivity at a time when happiness and positivity needed to be brought; football is not “the most important of the least important things,” it is the least important of the most important things.

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