Tough on outcomes, tough on the causes of outcomes

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Stephen O'Brien, the shadow health minister, made a shock admission at The King's Fund event at the Conservative Party conference last night – far from being the source of all evil, targets could be a good thing.

It was a bit of shock as earlier in the day his boss Andrew Lansley had repeated his pledge to confine 'Labour's political targets' to the dustbin of history and move to a regime based on outcomes.

Admittedly Mr O'Brien's praise for targets was limited – he thought they could be useful to 'jump start' change but added that they had had their day. The interesting point is that this is not a million miles from Labour's acceptance that targets may be subject to a law of diminishing return and that targets for providers should become entitlements for patients.

It was a brave performance from Mr O'Brien – he also acknowledged that moving from targets to outcomes was not going to be easy. Outcomes, he admitted, often can be measured only over the long term and may not fit in with political timescales.

It must be right for the politicians to find better ways of measuring NHS performance and in principle outcomes are better than process measures. But even process targets can still have a place, especially where we cannot establish clear outcomes or when the process itself matters. Speed of access will still be important for patients – the NHS needs to be responsive as well as efficient and effective.

Oh and there was one more piece of O'Brien courage – he suggested that the Conservatives would welcome an opportunity to meet with the social care minister Phil Hope, even at this late stage, to see if they could achieve political consensus on social care funding reform. Over to you Phil.


Rob Hutchinson

Comment date
13 October 2009
Mr OBrian is right to say that it will be difficult to move from targets to outcomes; Because the regulators (of all kinds) have focused on, the easier to identify, process measures, they have reinforced a culture of organsiations ticking boxes and therefore giving more priority to the efficiency of their organisation rather than their effectiveness. Changing that culture will be difficult but if real change is to be achieved in public services the measures of success have to be seen as those which make a difference to people and communities rather than inward looking bureaucratic achievements.

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