The number of NHS performance management targets should be cut radically and more flexibility allowed in the way trusts can achieve targets, say NHS Confederation briefings.

The confederation has published three briefing papers on what is wrong with the performance-management agenda, and how it should change so the service is not driven by meeting imposed targets.

The briefings say that when people are asked to focus on so many targets, 'target fatigue can set in'.

Because the patient experience is not being properly measured, a situation could arise where 'we could implement all 365 targets in the NHS plan and still find patients and the public dissatisfied with the NHS'.

The papers conclude that the 'key to the whole system' is to have 'no more than five or six' highlevel targets. They say: 'It requires politicians to define a very small number of targets that describe what they mean by modernisation, and against which success or failure will be measured.'

The briefings also say that innovation and progress cannot be achieved without a diversity of approaches, and that different organisations must work together.

Dealing with accident and emergency trolley waits, for example, may require interventions in primary, intermediate and social care, as well as efficiency improvements in hospitals.A key rule of performance management is that 'where possible, measurement should be to inform improvement, not for selection or punishment'.

The third paper, Rethinking the system, says that as there are 400 million individual patient encounters with the NHS a year, patients need a greater involvement in ensuring quality is improved.

Leading edge 1: Why will not the NHS do as it is told - and what might we do about it? 2:

Aligning what we say and how we behave. 3: Rethinking the system. NHS Confederation.

www. nhsconfed. net