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 gambles that the EU will blink first

In her Brexit speech, the Prime Minister raised the stakes by declaring that "no deal for Britain is better than a bad deal for Britain". 

It was at Lancaster House in 1988 that Margaret Thatcher delivered a speech heralding British membership of the single market. Twenty eight years later, at the same venue, Theresa May confirmed the UK’s retreat.

As had been clear ever since her Brexit speech in October, May recognises that her primary objective of controlling immigration is incompatible with continued membership. Inside the single market, she noted, the UK would still have to accept free movement and the rulings of the European Court of Justice (ECJ). “It would to all intents and purposes mean not leaving the EU at all,” May surmised.

The Prime Minister also confirmed, as anticipated, that the UK would no longer remain a full member of the Customs Union. “We want to get out into the wider world, to trade and do business all around the globe,” May declared.

But she also recognises that a substantial proportion of this will continue to be with Europe (the destination for half of current UK exports). Her ambition, she declared, was “a new, comprehensive, bold and ambitious Free Trade Agreement”. May added that she wanted either “a completely new customs agreement” or associate membership of the Customs Union.

Though the Prime Minister has long ruled out free movement and the acceptance of ECJ jurisdiction, she has not pledged to end budget contributions. But in her speech she diminished this potential concession, warning that the days when the UK provided “vast” amounts were over.

Having signalled what she wanted to take from the EU, what did May have to give? She struck a notably more conciliatory tone, emphasising that it was “overwhelmingly and compellingly in Britain’s national interest that the EU should succeed”. The day after Donald Trump gleefully predicted the institution’s demise, her words were in marked contrast to those of the president-elect.

In an age of Isis and Russian revanchism, May also emphasised the UK’s “unique intelligence capabilities” which would help to keep “people in Europe safe from terrorism”. She added: “At a time when there is growing concern about European security, Britain’s servicemen and women, based in European countries including Estonia, Poland and Romania, will continue to do their duty. We are leaving the European Union, but we are not leaving Europe.”

The EU’s defining political objective is to ensure that others do not follow the UK out of the club. The rise of nationalists such as Marine Le Pen, Alternative für Deutschland and the Dutch Partij voor de Vrijheid (Party for Freedom) has made Europe less, rather than more, amenable to British demands. In this hazardous climate, the UK cannot be seen to enjoy a cost-free Brexit.

May’s wager is that the price will not be excessive. She warned that a “punitive deal that punishes Britain” would be “an act of calamitous self-harm”. But as Greece can testify, economic self-interest does not always trump politics.

Unlike David Cameron, however, who merely stated that he “ruled nothing out” during his EU renegotiation, May signalled that she was prepared to walk away. “No deal for Britain is better than a bad deal for Britain,” she declared. Such an outcome would prove economically calamitous for the UK, forcing it to accept punitively high tariffs. But in this face-off, May’s gamble is that Brussels will blink first.

George Eaton is political editor of the New Statesman.