Lord Hunt on targets and inspections

Published: 04/03/2004, Volume II4, No. 5895 Page 19

Be warned. The phoney war is over and the pre-election campaign has begun. No day passes without a new pronouncement on the NHS from one or other of the political parties.

And no prizes for guessing that delivery and funding of public services will be a core issue for the election. Just as interesting, though, are the searching questions being asked about the value of targets and regulation.

Given the dire state of the NHS in 1997, I would always defend the government's target-setting approach - particularly on the back of the huge increase in money coming into the NHS.

My first lesson on entering the Department of Health was that the levers of power were hard to find.You could issue guidance and instructions till the cows came home, but guaranteeing implementation was quite another matter. Targets, crude as they may have been, were the one way to guarantee delivery.

But now so much progress has been made that the government has signalled a welcome approach to move the agenda on. Foundation trusts, patient choice and payments by results ought to provide many of the incentives that were previously provided by targets.

Many, but not all. There will always be a need for some targets in a national service funded by parliament. And ministers have no reason to abandon the concept of assessing individual NHS organisations and the publication of data.

How such assessments take place is, of course, a matter which very much exercises Commission for Healthcare Audit and Inspection chair Professor Sir Ian Kennedy. The signals are positive in his desire to produce a more sophisticated approach to performance measurement. If anyone can do it, he can.When I had responsibility for performance ratings, there was no question that we wanted the focus to be on clinical outcomes. The problem was the lack of credible information.

The NHS is not alone in its search for a more mature way to judge performance. The recent addition of added-value tables for schools is a tacit acknowledgement that crude exam league tables tell you more about the social mix of the school than the quality of the education provided.

There is also much soul searching about the Ofsted approach to inspections. There has recently been a riveting debate in Birmingham on this. The head of Lordswood Girls' School celebrated being judged the best school in the country for improving GCSE results by launching a full-blooded attack on Ofsted. She criticised the quality of their inspectors who, she said, were more of a hindrance than a help.

Several other heads piled in after her.

A straw in the wind, perhaps. It certainly suggests that we may be entering a new era in which regulators and would-be target setters will increasingly have to justify their actions. But it takes two to tango.Hospitals and schools, in arguing for a less oppressive regime, will have to show they can produce the goods in a more trusting environment. If performance slips back, you could never rule out a return to good ol'micromanagement from the centre.

Lord Hunt is chair of the National Patient Safety Agency and a former junior health minister