Intended for healthcare professionals

Rapid response to:

Analysis And Comment Health policy

Have targets improved performance in the English NHS?

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7538.419 (Published 16 February 2006) Cite this as: BMJ 2006;332:419

Rapid Response:

Re: No more auditors - please

We are delighted that Mr Williams, having had front line experience
of the regime of star ratings, agrees with our assessments of their
beneficial impacts and limitations. And we in turn agree with the points
he raises about our suggested remedies for uncertainty and audit, and are
grateful for the opportunity to clarify what we intended here. Chief
executives of NHS organisations ought to know how their organisations will
be assessed. (When the Commission for Health Improvement (CHI ) took over
responsibility for star ratings from the Department of Health, one of our
objectives was to let the NHS know the basis of ratings as soon as this
had been agreed with the Secretary of State.) Our paper's emphasis on
uncertainty was primarily directed at the measurement of performance
against previously-stated targets. It is paradoxical (if not
Machiavellian) that, despite the NHS being overburdened with auditors,
there is no systematic audit of reported performance against targets; and
that evidence of gaming emerges serendipitously: for example, with
evidence given to the Public Administration Select Committee (1) and from
CHI's clinical governance reviews of ambulance trusts (2). Our paper was
seeking not to add to the NHS burden from auditors, but a realignment of
auditing to recognise the centrality of targets and the corrosive
consequences of gaming.

References

1. Public Administration Select Committee. Fifth report on target?
Government by measurement. London: Stationery Office, 2003.
www.publications.parliament.uk/pa/cm200203/cmselect/cmpubadm/62/62.pdf
(accessed 27 Feb 2006).

2. Commission for Health Improvement. What CHI has found in ambulance
trusts. London: Stationery Office, 2003.
www.healthcarecommission.org.uk/NationalFindings/NationalThemedReports/A...
(accessed 27 Feb 2006).

Competing interests:
GB was director of the office for information on healthcare performance at the Commission for Health Improvement until September 2003.

Competing interests: No competing interests

27 February 2006
Gwyn Bevan
Professor of Management Science
Christopher Hood
London School of Economics and Political Science, WC2A 2AE