Principles are better than targets

Over the last 20 years governments across the UK and beyond have sought to improve public service performance by introducing an array of targets, league tables and performance information.

Whilst the introduction of performance targets has certainly improved performance in specific areas (e.g. NHS waiting times in England) experts have also pointed to a number of problems with this type of approach including ‘gaming’.

Partly in response to some of the challenges associated with targets based ‘New Public Management’ there has, in the last few decades been a growing international interest in outcomes based performance management that more closely align measures of public service performance with the experience of users.

Wellbeing is a multi-dimensional concept that encompasses social, environmental and economic outcomes. A number of governments are using wellbeing frameworks to measure progress against these outcomes and to guide the development of policy and practice.

Wellbeing frameworks and outcomes based approaches can offer a number of benefits including more joined up approaches to government and citizen engagement but outcomes are not immune to gaming and there are challenges regarding attribution, impact and measurement.

In their paper Being Human: A Human Rights Based Approach to Health and Social Care in Scotland the Alliance argue that a Human Rights based approach to health and Social Care that supports people to be independent, active citizens as well as have good health could offer the basis for high quality social care.

John Seddon, in his book ‘The Whitehall Effect’ argues that a whole system change is required moving away from targets, regulation and compliance altogether.

The secret of a good service Seddon argues, is to focus on giving customers what they need.

There is however significant evidence against Seddon’s approach. There is for example, good evidence to suggest targets can also improve outcomes particularly when it comes to raising minimum standards and that politicians may find it difficult to limit themselves to defining purpose only.

A good example of the use of an outcomes based wellbeing framework to improve public services is Scotland National Performance Framework and the development of a shared assessment process for the care of older people in Dundee provides a practice based example of service design based around purpose and customer focus rather than top down targets.