Using and removing national performance targets in the NHS

In the last 15 years, the delivery of national targets has arguably had a greater impact on NHS performance than any other policy lever available to system stewards, including patient choice, competition, regulation, reorganisation and transparency.

The delivery of targets was a significant part of the public service reform agenda under the 1997-2010 Labour government. NHS targets included:

• cutting waiting times
• increasing capacity
• reducing hospital-associated infections
• improving mortality for the big killers such as cancer and cardiovascular disease.

However, targets have also had a number of drawbacks and have been criticised for distorting clinical priorities, creating perverse incentives and providing scope for gaming – hitting the target but missing the point.

This was why in 2010 the coalition government committed to replace national targets with a broader set of outcome measures. But the coalition encountered difficulties with implementing this commitment, which remained unrealised by the 2015 general election.

Many national targets continue in force and new targets have been set in mental health, while the main political parties all made commitments that may evolve into a new generation of targets after May 2015.

As targets seem likely to remain part of the NHS in some form, this project aims to identify practical ways for policymakers to make the next generation of targets better than the last and make more effective cases to amend or remove existing targets that are no longer helpful or practical.

Contact details

For more information about this project, please contact Tim Gardner.