Academics back NHS targets and local pay

20 Apr 10
Experts have hit out against political moves to abolish health service targets and centrally control public sector pay

By Lucy Phillips

20 April 2010

Experts have hit out against political moves to abolish health service targets and to continue to centrally control public sector pay.

The Centre for Market and Public Organisation at Bristol University said that targets to reduce waiting times for elective care and other treatments, introduced by Labour in the early 2000s, had worked. The centre’s research also showed that the targets had not had the harmful effects on health that medical unions had feared.

But all the main political parties’ manifestos are now signalling moves away from Whitehall-imposed targets, which are often unpopular among staff and seen as too bureaucratic.

Carol Propper, report author and professor of economics of public policy, told Public Finance: ‘Targets have worked even though everyone is saying we are not going to have a target culture... You would be daft as a politician to throw the baby out with the bath water and say we are not going to have any targets. It’s a fairly incredible position.’

Labour has pledged to introduce legally binding guarantees for patients, such as the right to cancer test results within one week of referral, as a replacement for national targets while the Conservatives have promised to scrap ‘process’ targets, instead focusing solely on outcomes. The Liberal Democrats plan to reduce the number of centralised targets, substituting them for patient entitlements to diagnosis and treatment.      

Propper added: ‘I think the Tories will find, if they get into power, targets will be part of their armoury to improve productivity. A few well chosen targets might be useful to them and increase the kind of productivity targets they want. They have to be focused on something everybody agrees needs to be addressed.’ She advocated the LibDems’ policy of focusing on ‘a few really well chosen targets’. 

But a spokesman for the Conservatives told PF: ‘Things like waiting times are not going to go up because of the idea of scrapping targets. A lot of the benefits have come from increased capacity, not targets. If you are going to focus on results and outcomes, people still need to be seen quickly.’

He added that the Tories would have some ‘overall targets for government to be seen to be making progress on’ in areas such as obesity and alcohol abuse. ‘The health service won’t have to respond to bureaucrats, it will have to respond to patients,’ he said.

The research also found that centralised pay setting for health workers was putting lives at risk, as areas with higher average wage levels had problems recruiting, retaining and motivating good NHS staff, harming hospital performance.

While all parties have indicated intentions to clamp down on public sector pay, Propper said ‘no-one has said anything putting their heads above the parapets’ and there were no specific details for NHS workers in the manifestos.

Propper warned against attempts to ‘repress the effect of the market’ through tighter central controls, backing local pay bargaining as a way of ‘slimming down’ the public sector.

‘Cut the pay or don’t increase it in areas that are low cost, such as the Northwest and Northeast, and you would not have a detrimental impact on services. But cut the pay in high-cost areas like London and you could damage services,’ she said.

She added that more local wage flexibility ‘might be one of the ways of squaring the circle between the need for public services and reducing the deficit’.

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