Review of targets and indicators for health and social care in Scotland

Targets and indicators in the public sector

16. The concept of managing public services by use of targets emerged in the 1980s. Government set about improving the efficiency of public services by making them more business-like. This new approach, known as New Public Management, focussed on "customer service" which was defined as the "...centrality of citizens who were the recipient of the services or customers to the public sector. "Citizens" became "customers" of public services.

17. New Public Management allowed experimentation with decentralized service delivery models, giving local organisations more freedom in how they delivered programs or services. In England, and, for a short time, in Scotland, market like structures were set up to create competition in health care between the public and the private sector. The health service became an internal market, with self-governing Trusts, GP fundholding and commissioning of services for example.Critics of such systems saw them as ways to distance Ministers from responsibility for difficult decisions while proponents saw them as ways of increasing efficiency while improving "customer service."

18. Other important themes for New Public Management were "financial control, value for money, increasing efficiency, identifying and setting targets and monitoring of performance". In particular, performance was assessed using audits, benchmarking and performance evaluations.

19. While it can be argued that targets are necessary to set direction for an organisation and motivate staff to achieve the goals of the business, some management scientists have suggested that targets are the remnants of a discredited command and control system which demotivates staff and causes them to focus on the wrong aspects of their work. The challenge in this review is to suggest a process of designing targets and indicators in association with those who deliver services and those who use them. In that way, frontline staff can be encouraged to innovate and, through working with those who use services, find ways of improving them more effectively.