Putting On A Performance
The Chief Inspector of hospitals has expressed his shock at the practice, which may have put the lives of cancer patients at risk.
Though disturbing, we should not be entirely surprised at such practices. There are countless examples of ‘massaging the figures’ not just in health but in other areas of the public sector such as crime, the economy, and education.
The thinking that underpins the contemporary use of performance targets is that public sector employees are (like all people) driven solely by self-interest. In the process of advancing their career and maximising their power and resources (so-called empire-building), they permit waste and inefficiency, and indulge special interests. This portrait of civil servants was comically and brilliantly conveyed in the TV show Yes Minister.
The solution adopted by the Thatcher government, and further expanded under the Premierships of Major and Blair, was to subject to civil servants to the discipline of the market, on the assumption that it harnesses self-interest to socially beneficial ends. Accordingly, the use of performance targets and performance-related pay attempted to mimic market pressures and incentives.
There have been a number of negative consequences. The web of targets, the burden of data collection and analysis, have added to rather than lessened bureaucracy. Managers have been empowered at the expense of professionals. And people have been incentivised to engage in precisely the sort of ‘gaming of the system’ revealed in Colchester. Furthermore, politicians have a stake in the manipulation, as the ‘sexed up’ figures provide evidence that they are doing a good job. These dynamics are notably satirised in The Thick of It, the modern equivalent of Yes Minister.
Of course it is important to be clear about what constitutes good service and to be able to measure progress. But only a fraction of what matters is amenable to measurement and selfishness is only one aspect of what motivates people. An approach based around these narrow poles risks improving performance in a theatrical sense only - creating a spectacle of success.