More than a decade ago, I was asked by a member of Tony Blair’s cabinet (to pass the time of day) what I was writing about. I had just published a book about new kinds of money, and I told him I was writing about our habit of measuring too much.He looked completely non-plussed – targets were regarded as a vital and clever innovation in those days – and said: “But what else can you do?”
The news from Colchester General Hospital, where managers are said to have bullied staff into falsifying target data, confirms that it is now time we worked out an urgent answer to this question.
The problem about using numbers to control is that they only give the appearance of hard objective data. In fact, the numbers are chained inexorably to definitions, which involve words which can be endlessly manipulated.
The truth is that the target culture, which the coalition has failed to completely confront, creates a kind of cage where – the more safeguards you put in – the more difficult it is to operate at all without manipulating those definitions.
When a hospital has to bully staff to manipulate figures, then you clearly have evidence of a failing hospital, and there have been complaints about Colchester for some time now. But the real point is that Colchester is just the tip of an iceberg. We are still living with the cage of numbers woven by Gordon Brown.
This is the advice of system thinker John Seddon, that manipulation is absolutely endemic, and it isn’t the fault of the frontline staff who do the manipulation – it is the fault of the system that requires it.
Worse, the advent of turbo-charged targets with money attached (payment by results contracts) turns that manipulation from a simple but regrettable management habit into outright fraud.
The problem is that this manipulation gets so habitual, in every sector, that it takes up most of the creative energy of the staff and managers (I don’t exaggerate), and it spills over into outright falsification – which seems to be what has happened in Colchester.
This kind of control by measurement carries within it a kind of fantasy about objectivity. It is the fantasy also that you can somehow measure outcomes, real objectives – not the pretend outcomes that service managers gargle with – and that all you need to do is check up on the process, and the great humming machine that will get you there.
The coalition rejected the symptoms of this Blairite fantasy, but allowed themselves to continue the great humming machine fantasy. Hence the current difficulties.
And this is just the beginning. This time, next time, or the time after, the scandal will result in a widespread investigation into the manipulation of targets, especially in privatised services, which will find that it is absolutely ubiquitous. The emperor will clearly have no clothes then, so work is going to have to start now on the system that replaces it.
But I could not put the problem any more clearly than the influential NHS blogger Roy Lilley this morning. This is what he said:
"The toxic cocktail of targets, savings, inspection, reputation-saving, top-down bullying, confused responsibilities and hubris is making the NHS unmanageable and dangerous. Inspection does not make us safer. People do, People don’t come to work as liars, target fiddlers and cheats; it's what organisations reduce them to."
Quite so. It really is time the coalition got to grips with this toxic legacy of the old regime.
3 comments:
I agree with you, David, there's too much data-fetishism. Measure quality and it comes out as quantity etc. But... what would you replace it with? How would you choose to compare whether a hospital / school / prison / whatever in Doncaster or Torquay or Tower Hamlets is doing a good enough job with public money?
I agree with you, Stephen. It's one thing to say how destructive target culture is, and how expensive. I think we know how to provide managers with what they need to be much more effective, but we still don't know how to give politicians what they need to hold services to account - that's the big question. And I'm going to answer it!
I agree with you, Stephen. It's one thing to say how destructive target culture is, and how expensive. I think we know how to provide managers with what they need to be much more effective, but we still don't know how to give politicians what they need to hold services to account - that's the big question. And I'm going to answer it!
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