Neonatal care is being wrecked by too many targets, not too few

The Guardian reports today on a National Audit Office report that criticises botched reforms to neonatal care:

"Scores of premature babies may be dying unnecessarily across England because the NHS mismanaged a reform of neonatal units in 2003, parliament's spending watchdog reveals today."

Most of the Guardian's account speaks for itself but this section needs some attention:

"Jacqui Smith, when health minister in 2003, said she agreed with recommendations from the British Association for Perinatal Medicine for minimum staffing ratios. But the government did not order NHS trusts to implement them.

The NAO says there was "confusion" over whether staffing ratios were mandatory, making it difficult for unit managers to convince NHS trusts they needed more staff."

This might be taken to suggest that a lack of targets and other central intervention was the problem.  The NHS Trusts were waiting around for the Health Minister to tell them what to do and without the wisdom of the Department of Health things went wrong.


The truth is that too much central intervention, not too little, is the problem.  When you have so many targets and so little local discretion - as pay, drugs, funding and IT expenditure and a host of management decisions are made centrally - anything that isn't made a target is ignored.  Local decision making can always go wrong but biasing decisions towards prioritising outcomes that central Government is able to, and gets around to, making a target will lead to worse decisions overall.  That is the case here: the target culture is to blame for making a target necessary.

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