The health secretary, Matt Hancock, has proclaimed victory on his promise to run 100,000 coronavirus tests per day by the end of April. He was right to devote attention to the UK’s relatively low testing capacity. But the target and the 30 April deadline were arbitrary, driven by media pressure and divorced from consideration of a wider testing strategy.
Of course, Hancock is not the first minister to try and defuse criticism with a headline-grabbing call to action. And he’s not the first to find the number 100,000 particularly beguiling. This round figure was chosen as a net migration target by the Cameron government, and Tony Blair came to office promising to reduce NHS waiting lists by the same.
Highly visible targets can galvanise action within government. But they can create bigger problems when means are confused with ends, and rather than supporting a high-level policy goal, the target itself supplants the policy in the eyes of the public, media, ministers and civil servants.
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Targets need to be informed by evidence and high-level goals, not media strategy
Attention-grabbing targets have a habit of being led by political strategy, rather than evidence or thought about where they sit in the context of a government’s policy goals. David Cameron’s net migration target was set against a backdrop of public anxiety about migrants. But it was not preceded by an overarching plan or due consideration about its feasibility.
Blair’s NHS commitment featured as one of five on the famous 1997 pledge card. One of its authors described this as a “marketing device” and the waiting list targets in particular as a “largely irrelevant measure”. Blair quickly realised the figure did not match the scale of the issue, and his government introduced new targets.
The advice behind Hancock’s commitment has not been made public, so it is premature to conclude it was led by political calculation. Targets do serve a purpose, but public explanations for this one have not been particularly convincing. The target did not come from SAGE, and representatives of Public Health England and the NHS did not offer the Science and Technology Committee convincing detail as to why it was appropriate or where it fits within the government’s overall strategy.
A singular focus on targets can undermine other goals
Public focus – and the attendant pressure to deliver – on highly visible targets can crowd out or undermine other policy goals. In the case of coronavirus testing, there’s a question about whether bureaucratic bandwidth might have been diverted from a longer-term testing strategy or ensuring test sites were in places accessible to NHS staff.
Migration policy is – or should be – underpinned by a complex mix of goals, like economic growth and foreign relations. But under Cameron and then Theresa May, these were subsumed by the prominence of the net migration target. For instance, the government scrapped the post-study work visa in 2012 (a decision recently reversed). While this cut migrant numbers, it also meant the loss of international students’ tuition fees, which cross-subsidise other university activities like research.
Blair’s waiting list target arguably undermined broader priorities within the health system, with accusations of neglect of urgent patients to drive down numbers.
Number-based policy commitments can make it difficult to change tack
Blair met his target and so was able to switch to another based on waiting times, which his government recognised as being of greater concern to patients than the number of people on lists. But in other cases, sharp public focus on a single number can make it harder for a government to pivot. Having given the net migration target such prominence, the Conservative government stuck with it long after it was apparent it could not be met.
In the case of testing, a pledge to ensure all NHS workers who needed a test could access one might have been a meaningful goal that offered more flexibility about the means. It also could have avoided the need to continually expand testing eligibility and alter the classification – test available, or test conducted – in the days leading up to the deadline, rather than admit it didn’t need to run 100,000 tests on 30 April.
Assuming the next stage of the coronavirus response does require more testing capacity, Hancock’s gimmick will have helped lay the framework. However, it may have diverted attention from other critical areas – not least what architecture will be needed to deliver a nationwide test, track and trace system. The episode has shown the power of targets to focus minds and action – but also that governments should be wary of confusing means with ends.