Intended for healthcare professionals


Lessons from the Windrush generation

BMJ 2018; 361 doi: (Published 08 May 2018) Cite this as: BMJ 2018;361:k2017
  1. Martin McKee, professor of European Public Health
  1. London School of Hygiene and Tropical Medicine, London, UK
  1. martin.mckee{at}

A culture of targets threatens many vulnerable groups

The resignation of the UK home secretary Amber Rudd has drawn attention once more to the consequences of using targets in the public sector. Since 2010, British migration policy has been dominated by a target aiming to reduce net migration from the “hundreds of thousands” to the “tens of thousands.”1 To achieve this, Theresa May, then home secretary, created a “hostile environment” requiring everyone to provide documents confirming their right to be in the country, whether to access public services or to get a job or rent accommodation. Previously immigration officials might have applied their judgment when someone was unable to meet the by now exceptionally high burden of proof, requiring original documentation going back many decades, but the deportation targets provided a powerful incentive to deny someone a right to remain.

Origin of public sector targets

The widespread use of measurable targets to hold public sector organisations accountable dates from the 1980s, forming a core element of so …

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