comment: Command and control structure is a habit That is hard to break

Published: 22/07/2004, Volume II4, No. 5915 Page 17

The government's bonfire of targets rages on. The planning framework for the next three financial years has 42 fewer targets than its predecessor published in September 2002 (news, pages 6-7).

The smell of burning memoranda is the smell of freedom for the NHS. But do not let the smoke get in your eyes; the conflagration is not quite all it seems.

First, it is proving difficult to stick to the pledge not to introduce new national targets.

Back in February health secretary John Reid declared: 'I will not replace centrally driven targets by more centrally driven targets.'

But the NHS improvement plan and the latest public service agreements saw a range of new national targets. Let us be kind and suggest that all were sensible tweaks of existing targets rather then replacements, or were reflections of a health service moving on to prevent ill health rather than curing it.

The same cannot be said for the target on reducing hospital-acquired infections. There is clearly a problem and action needs to be taken. But when faced with frothing at the mouth in sections of the media, the government could simply have said, 'we trust the NHS to tackle this problem at local level'. Instead it has introduced a national target.

Then there is the nature of the new or remaining targets - they tend to be much broader based than many of the ones that are disappearing. The end of overly prescriptive targets is a good thing, but it is telling that the new objectives come with supporting paragraphs of explanation full of phrases such as 'primary care trusts and their partners will be encouraged...' Not that the struggle to move away from central control is entirely the government's fault. The NHS is full of calls for central guidance about this or that to be published as soon as possible. No wonder the Department of Health felt the need to publish criteria for setting local targets.

Finally, there are always going to be concern about what impact such a significant reduction in targets has on service priorities. The new planning framework appears to continue the trend of downplaying the importance of mental health.

Make no mistake, this planning framework is both welcome and highly significant.

But in attempting to encourage greater local autonomy, it also highlights quite how hard it is to break the command and control habit. l