The quest for effective regulation and performance management in UK public services

Regulatory bodies and performance management systems have proliferated in recent years in UK public services. Furthermore, as the shortcomings of one body or system are revealed, the preferred solution is frequently to replace them with new versions. This approach is costly and often does not seem to solve the problems it seeks to address. Indeed the result can be confusion and diminished performance at least in the short term as new people try to get to grips with the problems that their predecessors failed to solve. The new approaches have tried to replace trust in professionalism of individuals with monitoring of formalised performance measures, in an effort to improve economy, efficiency and effectiveness. As is well-documented in the literature, the focus tends to be on the first two of these, as the third is notoriously difficult to measure. Examples abound of the dysfunctional consequences in health and education, to name but two areas of public services, as organisations strive to ‘meet the target’, but unfortunately ‘miss the point’. This paper will review relevant literature and publicly available documents on regulatory and performance management practices in UK public services in recent years, with a particular focus on the English National Health Service (NHS). It will investigate the changes that have occurred as new regulatory bodies and performance management systems have come to replace old ones, including the cost implications and outcomes of these changes. Drawing on the evidence of the recently-concluded public inquiry into events at Mid-Staffordshire NHS Trust (www.midstaffspublicinquiry.com), where it is believed hundreds of patients may have died needlessly as the organisation struggled to achieve a particular performance target (maximum four hour waiting time for patients arriving at hospital Accident and Emergency departments), the study will discuss not only performance management issues, but also the broader concerns raised regarding regulatory bodies and their fitness for purpose. It will also consider the future for healthcare in England, with a discussion of the latest developments in appointing Monitor as an economic regulator tasked with extending competition in the sector.