Why do NHS managers want to keep targets?

The Public Service web site reports on a survey where 59% of NHS managers say they want to keep the targets that are being dropped by the new government.

Andrew Lansley has said that the 48 hour GP target, the 4 hour A&E target and the 18 week GP to treatment target are to be gradually scrapped by his department.

Former NHS trust chairman Roy Lilley said:

“Targets have made managers’ jobs really tough. They have taken a lot of criticism about additional bureaucracy and box ticking. I thought they would be pleased to see the back of them. Not so! Managers are proud of the fact they have delivered most of the targets and dumping targets is turning the clock back.”

Targets make managers jobs tough because they prevent managers working on what is important to the patient. They are instead distracted by having to hit the target. They should be glad to see the back of the targets since now they can run their services on the basis of giving value to patients. They shouldn’t be proud of delivering targets that make performance worse.

More importantly with the freedom from arbitrary targets, the clock can move forward apace. That freedom shouldn’t see the clock turned back to long waiting times, rather without having to appease an unjustifiable target they can now innovate to provide services that no-one would ever dream of setting as a target.

Why 18 weeks? Why not 18 days or 18 hours? There was no reason and there is even less reason now with the burden of centrally imposed targets removed.

Another manager said,

“Targets do, at least, stimulate productivity. Areas without targets tend to get sidelined. Without targets, for many people, it is human nature to ‘do what is easiest’, rather than what is best for patients.”

Firstly, targets don’t stimulate productivity, they stimulate activity, which is not the same thing at all.

Secondly, the quote shows a very cynical view of people. This is a view that staff are inherently lazy and don’t want the best for patients. I don’t believe that and I think that the only thing holding back improvement is a lack of sound method. But there is plenty of good ways of improving if managers look for it. It is not laziness that is the problem, is the laziness of thinking that assumes that people are slothful and will shirk the responsibility to improve things for the public. It is just that some of them don’t know how to do it yet.



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  1. Jon Harvey -

    Totally agree – we need a bonfire of the targets. My thoughts are here: http://jonharveyassociates.blogspot.com/2009/07/bonfire-of-targets.html

    Lets keep campaigning to turn the clock forward!

  2. glynlumley -

    Excellent post Rob

    I wonder if managers cling to targets because they know no alternative method? No-one has shown them what an understanding of systems and why works varies can achieve.