Newspaper article The Journal (Newcastle, England)

When Governments Set Targets, Perverse Incentives Are Created; Columnist

Newspaper article The Journal (Newcastle, England)

When Governments Set Targets, Perverse Incentives Are Created; Columnist

Article excerpt

Byline: Bernard Trafford

TO read, listen to or watch the news recently you might think it's the silly season.

That period is usually in late August where, lacking real news, journalists come up with daft stories. There's a difference currently: the stories are indeed genuine, but daft nonetheless. I've been longing to come across an example of plain common sense.

Instead we've been witnessing the ongoing travails of the National Health Service. Two revolutionary new ideas are being floated.

First, nurse training will henceforth emphasise basic patient care: washing and doing bedpans; feeding those too poorly or dispirited to eat; just being there, listening, talking and, yes, caring.

The next idea is to introduce regulation to require medical staff to demonstrate candour: they'll be required to be honest and open with patients and relatives about their condition and prognosis.

You'd have thought it obvious that patients need to know the truth: most of us have friends or relatives who have become desperate (and significantly more ill) while worrying about not knowing what was wrong with them or being done.

On Radio 4's Today programme on Tuesday, a doctor explained why a regulatory requirement to demonstrate candour would be counterproductive.

He was right.

Whenever governments set targets and measurable outcomes to which a service will be ruthlessly held, they create perverse incentives. It happens when schools are required to get a particular proportion of children over a set threshold.

Instead of creating the best chances for all children, focus falls too easily on pushing a borderline group over that required minimum, ignoring the rest and damping aspiration.

It's the same wherever government introduces targets: we don't get better practice, we just get a slightly improved minimum at the set borderline. Teachers, doctors, social workers, we all tell government. And ministers on a mission never listen. Indeed, professionals' candour with ministers is rarely welcomed. They seem to prefer to stick to their own daft ideas.

Finally, though, I was cheered to find some plain common sense that was both necessary and timely, something we all ought to take on board. …

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