The loss of control
Evidence-Based Medicine begat Evidence-Based Management which begat New Public Management which begat Performance Management, all in a drive to make state-run services covering health, policing and education more efficient and more business-like.
In each case the service in question were treated as if they were closed systems, where every problem had a solution waiting to be found, and every action had a predictable reaction.
In each case, the first step was to carry out baseline measurements against which governments could measure progress. The idea was that by taking sample measurements – ideally representative samples – you could get a reading of the condition of the entire enterprise, which would inform decision-making.
We will never know what the consequences would have been had the measuring had been done with some objective rigour, and had the choice of what was being measured been its significance rather than how easy it was to get at the numbers, and if the tools for measuring were up to the job. But as we have seen, this was rarely the case.
Even if the measuring had been done rigorously and appropriately, its usefulness to inform decision-making was entirely undermined as soon as the policy makers began to use the measurements as targets. It was at that point that the systems slipped out of control. The incentives and threats served to encourage individuals and management to game the numbers.
So powerful have the incentives been to achieve centrally determined targets, and so powerful have the threats been for those who risk failing to meet their targets, that for many – the administrators and the administrated alike – meeting targets has become the be-all and end-all of what they do on a daily basis, surpassing in importance not just the nuanced aspects of the job they have been trained to do and which many of them entered as a vocation, but the very raison d'être of the profession.
New Public management pushes people to focus on the only the aspects of their work that can be numerically quantified and to ignore what years of experience and common sense have taught them has significance.
It is hard to conceive of changes to public administration which would have made all this worthwhile. In fact, all the evidence suggests that the sacrifice of careers, the enormous costs, the lives shortened or damaged by stress, to say nothing of the thousands of premature deaths, have all been in vain. The system of Performance Management which set out to replace an inefficient and irrational system with one that was both rational and efficient has failed to meet its own targets.
As we have seen, by 2013, after nearly two decades of Performance Management, Foundation Trusts were so focused on hitting financial and waiting-time targets that they “forgot why they were there” and the Service’s supervisory organisations proved themselves to be impotent.
Spending is barely under control. In a well researched article in the Spectator in 2002, George Monbiot wrote that the Private Finance Initiative has led to a situation where every £200 million spent on privately financed hospitals will result in the NHS losing 1,000 doctors and nurses and where the first PFI hospitals contain some 28% fewer beds than the ones they replaced [2]. In 2007 Jean School of the Manchester Business School reported that funding hospitals from the private rather than public sector cost the NHS almost half a billion pounds more every year, a cost that ‘must reduce access to health care and other public services'. [3]
Patient satisfaction surveys from 1983 showed a steady increase in satisfaction until 2011, then,
So has the Police force become more efficient at solving crime? We simply do not know. As innumerable reports have shown, the police have gamed the figures on crime detection to the point that they cannot be trusted.
But if we cannot test the efficiency of the police when it comes to solving crimes, we can at least examine their efficiency at preventing them. The best and simplest measure is to compare the number of police employed in any one year with the number of reportedcrimes in the same period. This will produce a figure for the number of crimes per officer. If the police are becoming more efficient, then the number of crimes per officer should be going down.
In each case the service in question were treated as if they were closed systems, where every problem had a solution waiting to be found, and every action had a predictable reaction.
In each case, the first step was to carry out baseline measurements against which governments could measure progress. The idea was that by taking sample measurements – ideally representative samples – you could get a reading of the condition of the entire enterprise, which would inform decision-making.
We will never know what the consequences would have been had the measuring had been done with some objective rigour, and had the choice of what was being measured been its significance rather than how easy it was to get at the numbers, and if the tools for measuring were up to the job. But as we have seen, this was rarely the case.
Even if the measuring had been done rigorously and appropriately, its usefulness to inform decision-making was entirely undermined as soon as the policy makers began to use the measurements as targets. It was at that point that the systems slipped out of control. The incentives and threats served to encourage individuals and management to game the numbers.
So powerful have the incentives been to achieve centrally determined targets, and so powerful have the threats been for those who risk failing to meet their targets, that for many – the administrators and the administrated alike – meeting targets has become the be-all and end-all of what they do on a daily basis, surpassing in importance not just the nuanced aspects of the job they have been trained to do and which many of them entered as a vocation, but the very raison d'être of the profession.
New Public management pushes people to focus on the only the aspects of their work that can be numerically quantified and to ignore what years of experience and common sense have taught them has significance.
It is hard to conceive of changes to public administration which would have made all this worthwhile. In fact, all the evidence suggests that the sacrifice of careers, the enormous costs, the lives shortened or damaged by stress, to say nothing of the thousands of premature deaths, have all been in vain. The system of Performance Management which set out to replace an inefficient and irrational system with one that was both rational and efficient has failed to meet its own targets.
The NHS
The last major report on the state of the National Health Service before the introduction of Performance Management was the 1979 Royal Commission. The Chair, Sir Alexander Merrison summarised the findings in a retrospective essay in 1984:“The report gave the NHS a reasonably clean bill of health … As to value for money and patient satisfaction the NHS was doing well.” [1]
As we have seen, by 2013, after nearly two decades of Performance Management, Foundation Trusts were so focused on hitting financial and waiting-time targets that they “forgot why they were there” and the Service’s supervisory organisations proved themselves to be impotent.
Spending is barely under control. In a well researched article in the Spectator in 2002, George Monbiot wrote that the Private Finance Initiative has led to a situation where every £200 million spent on privately financed hospitals will result in the NHS losing 1,000 doctors and nurses and where the first PFI hospitals contain some 28% fewer beds than the ones they replaced [2]. In 2007 Jean School of the Manchester Business School reported that funding hospitals from the private rather than public sector cost the NHS almost half a billion pounds more every year, a cost that ‘must reduce access to health care and other public services'. [3]
Patient satisfaction surveys from 1983 showed a steady increase in satisfaction until 2011, then,
The 2018 survey, carried out by the National Centre for Social Research, is seen as a gold standard measure of public attitudes. It finds that, following a sharp drop in 2017, public satisfaction2with the health service fell by a further 3 percentage points in 2018 to 53 per cent, its lowest level in over a decade and 16 percentage points below its historical peak of 70 per cent in 2010. [4]Performance Management has failed utterly to make the Health Service more efficient and has resulted in increased patient satisfaction
The Police
Has the Police Force become more efficient since the introduction of Performance Management? How should we measure its efficiency? In the Statement of Common Purpose published by the Association of Chief Police Officers in 1990, the main function of the police are defined as “to pursue and bring to justice those who break the law” – to solve crime – and “to protect, help and reassure the community” – to prevent crime. [5]So has the Police force become more efficient at solving crime? We simply do not know. As innumerable reports have shown, the police have gamed the figures on crime detection to the point that they cannot be trusted.
But if we cannot test the efficiency of the police when it comes to solving crimes, we can at least examine their efficiency at preventing them. The best and simplest measure is to compare the number of police employed in any one year with the number of reportedcrimes in the same period. This will produce a figure for the number of crimes per officer. If the police are becoming more efficient, then the number of crimes per officer should be going down.
However between 1981 and 2011, when Performance Management was introduced, the number of crimes per officer increased nearly threefold from 23 to 67 crimes per officer. [6] [7]
Education
Can we tell if education has become more efficient since the introduction of Performance Management? Again, it is a question of measuring inputs and outputs. Measuring the quantity of inputs – the number of teachers and the resources and their deployment is an easy matter. Measuring the output is much harder because it is – or should be – qualitative.
Three scales have been devised to measure learning output internationally. PISA, the Programme for International Student Assessment, is intended to measure scholastic performance on mathematics, science, and reading; TIMSS focuses on knowledge of science and mathematics, and PIRLS, the Progress in International Reading Literacy Study, is an international study of reading achievement in fourth graders.
As assessments of educational attainment, all of them are extraordinarily one-dimensional. They measure only what can easily be tested numerically. And because a country’s position in a PISA league table has become a matter of international prestige, the government focus is on teaching to the test, focusing on literacy only in the areas of maths and science and English language. Creative literacies – visual, musical, and dramatic, as well as physical literacy are ignored in terms of output and are therefore neglected in the curriculum.
If we agree with Jim Callaghan's statement about the purpose of education, that it is to “equip children to the best of their ability for a lively, constructive, place in society, and also to fit them to do a job of work,” then any measure of the effectiveness of an education system will include an assessment of how well it prepares children for their future life.
The neglect of children’s creative literacies is the more surprising then when learn that the creative industries were worth £111.7 billion in 2018 to the UK economy (Department for Culture, Media & Sport 2015) , that the number of jobs in the creative industries has increased by 4% year-on year since 1997 reaching 3.2 million in 2018 a accounting for 1 in every 11 UK jobs, a proportion that is increasing five times faster than the rest of the economy. [8]
To put that into perspective, only the sectors of Hotels and Restaurants, Construction, Business Services, Administrative and Support Services, Education, Transport Storage and Distribution, and Health and Social Care employ more people.
A very significant number of children in education in England and Wales are most likely to find work in the creative industries. Pasi Sahlberg, the Harvard Professor of Education argues that
The only source of information about whether or not the full educational outputs have improved or declined since the introduction of Performance Management in education are Ofsted and the teachers themselves. Unsurprisingly, Ofsted said, as cited above, that improvements have been widespread[10]. But as we saw, some two thirds of schools said that the harm caused by Ofsted outweighed the benefits. Most critically the Academies Commission found “considerable evidence” that the current accountability framework “inhibits change and innovation”, so that the regime is failing to achieve its stated goal of improving education.” [11]
Meanwhile, according to the Office of National Statistics, UK public expenditure on education and training doubled in real terms between 1987/88 and 2010/11. [12]
As assessments of educational attainment, all of them are extraordinarily one-dimensional. They measure only what can easily be tested numerically. And because a country’s position in a PISA league table has become a matter of international prestige, the government focus is on teaching to the test, focusing on literacy only in the areas of maths and science and English language. Creative literacies – visual, musical, and dramatic, as well as physical literacy are ignored in terms of output and are therefore neglected in the curriculum.
If we agree with Jim Callaghan's statement about the purpose of education, that it is to “equip children to the best of their ability for a lively, constructive, place in society, and also to fit them to do a job of work,” then any measure of the effectiveness of an education system will include an assessment of how well it prepares children for their future life.
The neglect of children’s creative literacies is the more surprising then when learn that the creative industries were worth £111.7 billion in 2018 to the UK economy (Department for Culture, Media & Sport 2015) , that the number of jobs in the creative industries has increased by 4% year-on year since 1997 reaching 3.2 million in 2018 a accounting for 1 in every 11 UK jobs, a proportion that is increasing five times faster than the rest of the economy. [8]
To put that into perspective, only the sectors of Hotels and Restaurants, Construction, Business Services, Administrative and Support Services, Education, Transport Storage and Distribution, and Health and Social Care employ more people.
A very significant number of children in education in England and Wales are most likely to find work in the creative industries. Pasi Sahlberg, the Harvard Professor of Education argues that
“Countries that want to be higher on the PISA tables should understand what it truly takes to get there,”and that, he says, includes
“a balanced curriculum that has equal weight in arts, music, and sports, and academic studies.” [9]It is clear that if we are to consider the efficiency of the education system, we cannot ignore the quality of the education that the students receive – as the 2013 Department of Education Review of Efficiency in Schools does. Nor can we consider only those aspects that can be measured in numbers, because these are not the only aspects of what education should be doing.
The only source of information about whether or not the full educational outputs have improved or declined since the introduction of Performance Management in education are Ofsted and the teachers themselves. Unsurprisingly, Ofsted said, as cited above, that improvements have been widespread[10]. But as we saw, some two thirds of schools said that the harm caused by Ofsted outweighed the benefits. Most critically the Academies Commission found “considerable evidence” that the current accountability framework “inhibits change and innovation”, so that the regime is failing to achieve its stated goal of improving education.” [11]
Meanwhile, according to the Office of National Statistics, UK public expenditure on education and training doubled in real terms between 1987/88 and 2010/11. [12]
A failure of rationality
To behave rationally is to behave according to the evidence presented to you.We have seen many examples above, where in critical situations health administrators, senior police officers and – paradoxically – those concerned with education policy and all their watchdogs have failed conspicuously to learn from experience. So today we have a system of public administration that has produced catastrophic results, and which in spite of minor adjustments, continues to fail to meet its own targets, and which has never acknowledged its failure.
The descent from the ideals of evidence-based policy making to this kind of foolishness is, I would argue, the result of a combination of intellectually laziness, opportunism and a refusal to take responsibility when things have gone wrong.
Across public services, honourable people were pressured into falsifying the numbers to the point where no one knew any more what the true situation was, and they felt demeaned by what they were having to do. On top of that, the dedicated health workers, policemen and teachers found themselves torn between two imperatives. The imperative to act like a machine and the imperative to act like a human. The pressure to join this cult of what we might call artificial stupidity was often too strong to resist.
Across public services, honourable people were pressured into falsifying the numbers to the point where no one knew any more what the true situation was, and they felt demeaned by what they were having to do. On top of that, the dedicated health workers, policemen and teachers found themselves torn between two imperatives. The imperative to act like a machine and the imperative to act like a human. The pressure to join this cult of what we might call artificial stupidity was often too strong to resist.
Meanwhile those who ran the system in the name of rationality, who dictated the targets, but who passed all responsibility for attaining them down the line, were returning the systems to levels of inefficiency and irrationality at least as bad as those that their predecessors had revolted against.
From evidence-base policy to irrational dogma
By using baseline measurements as targets and introducing powerful incentives to meet those targets, governments hoped to encourage public services to follow the policies they set, and to force them to achieve ever greater efficiencies. Instead, people began to game the numbers. Targets which were designed to be indicators became ends in themselves – to the extent that dedicated workers were obliged to focus only on the numerically measurable aspects of what they did.
The result was that none of the public services can be shown to have become more efficient. The NHS, which had been doing quite well before, is now in a situation where its spending is almost out of control. Judged by the numbers of police employed against the numbers of crimes reported, the police forces are nearly three times less efficient than they were before the introduction of Performance Management. Measured as a way to equip children for a lively, constructive, place in society, and to fit them to do a job of work, education is now markedly less efficient than it was.
In our schools, pressures to focus on the Performance Indicators have narrowed the curriculum to the point that it neglects the needs of many children, and some two thirds of schools have said that the harm caused by Ofsted outweighed the benefits. Meanwhile spending on education and training has doubled in real terms.
Neither has Performance Management produced more rationality in decision-making. The numbers which provide evidence for performance indicators have been falsified to the extent that as even the Office of National Statistic admits, none can be trusted. When incontrovertible evidence has emerged that policies are failing, decision makers have shown an almost total inability and unwillingness to face reality and learn from their mistakes. We have gone from evidence-based policy to policy-based evidence, from evidence-based policy to irrational dogma.
In our schools, pressures to focus on the Performance Indicators have narrowed the curriculum to the point that it neglects the needs of many children, and some two thirds of schools have said that the harm caused by Ofsted outweighed the benefits. Meanwhile spending on education and training has doubled in real terms.
Neither has Performance Management produced more rationality in decision-making. The numbers which provide evidence for performance indicators have been falsified to the extent that as even the Office of National Statistic admits, none can be trusted. When incontrovertible evidence has emerged that policies are failing, decision makers have shown an almost total inability and unwillingness to face reality and learn from their mistakes. We have gone from evidence-based policy to policy-based evidence, from evidence-based policy to irrational dogma.
[1] Merrison, A. (1979). The Royal Commission in retrospect. In G. Teeling Smith (Ed.), A new NHS Act for 1996?London: Office of Health Economics.
[2] Monbiot, G. (2002, March 10). Private Affluence, Public Rip-Off. The Spectator.
[3] Shaoul, J., Stafford, A., & Stapleton, R. (2008). The cost of using private finance to build finance and operate hospitals. Public Money and Management, 28(2), 101-108.
[4] Robertson Ruth; Appleby, John; Evans, Harry; Hemmings, Nina (2019) Public satisfaction with the NHS and social care in 2018 R esults from the British Social Attitudes survey The Kings Fund, London
[5] Newburn, T. (2008). Policing since 1945. In T. Newburn (Ed.), Handbook of Policing.Cullompton: Willan
[6] The Office for National Statistics. Crime in England and Wales, Year Ending December 2012.London: ONS, 2012.
[7] Dennis, Norman, and George Erdos. The Failure of Britain's Police: London and New York Compared.London: Civitas:Institute for the Study of Civil Society, 2003.
[8] Creative Industries Council (2019) Creative industries growth surge continues in https://www.thecreativeindustries.co.uk/uk-creative-overview/facts-and-figures/employment-figures, accessed March 26 2020
[9] Sahlberg, Pasi. “The PISA 2012 scores show the failure of 'market based' education reform.” The Guardian, 8 December 2013.
[9] Department for Culture, Media & Sport (2019)
[10] Matthews, Peter, and Pam Sammons. Improvement through inspection: an evaluation of the impact of Ofsted's work.University of London. Institute of Education, Ofsted, 2011.
[11] Gilbert, Christine, Chris Husbands, and Brett Wigdortz. Unleashing Greatness: Getting the best from an academised system. The Report of the Academies Commission.Report, London: Pearson RSA, 2013, January.
[12] Office for National Statistics. “UK education spending more than doubled between 1988 and 2011.” www.ons.gov.uk.ONS. 19 May 2011. www.ons.gov.uk/ons/rel/social-trends-rd/social-trends/social-trends-41/social-trends-41---news-release---uk-education-spending-more-than-doubled-between-1988-and-2011.pdf (accessed May 11, 2015).
