CONCEPTOS DESTREZAS Y/O ACTIVIDADES

The first indication that the target setting process could be an issue in practice as well as theory came through the national overview survey data. When asked to make general comments on their perception of the LAA system, one area in the North West said “[our area] was coerced into accepting targets we knew we would not hit simply because they were a government priority. Whilst they were also a priority for [our area] - the targets were simply disaggregated from national targets and were too high for [our area].” The fact the area in question accepted that the general inclusion of the performance indicator reflected the priorities of the area, yet felt aggrieved at the nature of the target is telling. However, most telling of all, is the allegation that targets were simply reproduced from national attainment targets (which may be difficult to reach for areas facing concentrated levels of any issue (I.e. crime, deprivation). This viewpoint illustrated that whilst an area could be happy with the 35 indicators that it selected, they could still end

up with targets that were inappropriate or unachievable for their area, thus making the LAA ineffective. Although no evidence surfaced that it happened in practice, this also created the potential for a theoretical ‘double whammy’ whereby an area was forced into accepting an indicator that they did not want, coupled with an indicator target that was simply unachievable.

When exploring this issue at the case study level, within St Helens, it became clear that the issue of unachievable targets was a significant issue. In particular this centred on the target for reducing teenage pregnancy. Although reducing the teenage pregnancy rate in St Helens was widely accepted amongst partners as a major problem with the area, partners were largely agreed that the manner in which they were expected to deal with it through the LAA was unreasonable. This was due to two connected issues. The first was as a result of GOR seeking to be ambitious in the setting of the target so as to stretch the area, although one partner in St Helens described the level of the target as ‘harsh’ in that it would be very difficult to achieve. Secondly however, and more importantly, it was felt amongst some partners that GOR failed to understand the nuance of the target itself and how improvements would be achieved. With one partner pointing out that there are “things [referring to Teenage Pregnancy] which you only have so much control over if you’re realistic”. In seeking to explain the nature of these nuances, another partner noted that even if all appropriate means were put in place (i.e. sex education, sexual health services) it could still prove ineffective due to the inefficiencies of acting against an issue which does not have a simple technical solution, rooted in one cause.

Partners were also critical of GOR when seeking to mitigate these discrepancies between target and delivery, feeling that GOR were largely unsympathetic to local concerns. Discussing this, one partner related that during the negotiation there were “occasions where we got into situations where GOR officials would say ‘well that’s the target so tough’” further confirming that in some cases there was little flexibility to reflect justified local concerns.

It was also felt by partners that economic issues fell into the same category, in that the indicators/targets could fail to reflect the multi-faceted task of developing an economy. These concerns related to targets which particularly failed to consider issues outside of the local authority’s control (e.g. a company relocating etc) that could have a significant negative impact, despite best intentions and actions.

This underlines that there were occasions where significant top-down pressure was applied to local areas in order to enforce LAA targets that local practitioners did not feel were achievable, with little consideration for local characteristics, indicating once again that the LAA model could prove deficient in reflecting local considerations, even when they were expressly made.

However, John Denham contended that the process of unachievable targets would still serve to stretch LAAs in order to attain results that they might not if they were set a comfortably achievable target. As an example of what he meant, he described a discussion with a senior Accident and Emergency consultant in relation to the four hour maximum waiting time in hospitals;

“The idea of a four hour waiting time is nonsense. The other thing that you need to know is that the only way I manage to get this hospital to take my patients seriously is the four hour waiting time. I cannot defend it as a clinical measure, but until the hospital as a whole was forced to confront the problems we had, I couldn’t get them to

change…” l

Therefore, in John Denham’s view, the stretching of LAA targets could be construed as a way of forcing local areas to abandon complacent practices and reach further than they might not otherwise. What became clear, however, was that the art in this was to stretch the areas by just enough.