Key recommendations

  • National bodies involved in setting and managing targets must urgently develop a collective understanding about how current targets fit with their vision for the NHS over the next 5-10 years. Reviewing and potentially changing existing NHS performance targets will require strong political leadership.
  • Before deciding on a new national target, policymakers must consider whether it is the most appropriate means of achieving the desired outcome. Our report identifies five factors whose presence will increase the likelihood of targets effectively improving performance.
  • Any new target should be designed pragmatically (to manage gaps that may exist in the evidence base), collaboratively (with both patients and health care professionals) and iteratively (informed by regular review and adapted over time as necessary). The Health Foundation’s feedback loop model provides a framework to support policymakers in keeping new and existing targets under review.
  • To implement targets effectively, policymakers should focus less on penalties and more on supporting local commissioners and providers to develop the capacity and capability to make sustainable improvement. The creation of NHS Improvement provides an opportunity to refresh the approach to target management.

The use of national targets in the English NHS divides opinion. However, the NHS looks set to retain targets in some form for the foreseeable future, so the need to learn from accumulated experience of using targets over the last 25 years could not be clearer.

On targets: How targets can be most effective in the English NHS explores how national targets can be used most effectively to improve the quality of care provided by the NHS in England. It builds on what is known about the impact of targets to identify good practice in designing and implementing new or improved targets.

This report was informed by a review of existing evidence, research into public attitudes and engagement with clinicians and managers from across the NHS and from national organisations including those with expertise in setting, managing and reviewing targets.

Additional resources

This report was informed by a range of activities and other pieces of work.

  • A report of the deliberative events with the public undertaken as part of this project is available on the BritainThinks website.
  • An evidence scan on the impact of targets in the NHS and internationally was undertaken by ICF International.
  • We held a series of roundtable events with stakeholders. 

Further reading


Constructive comfort: accelerating change in the NHS

February 2015

This report asks how best to design national policy on the NHS to accelerate improvements to health...


Shaping the future

June 2015

The report provides a strategic framework for national leaders working to create a sustainable NHS...

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