Targets not realistic during axe-swinging
National has no target for paying GPs fairly or to support their work
National’s public sector targets are coming as it takes
an axe to the public sector.
Igrew up in a South Auckland house that was always full of visitors. My mum was the local GP and my dad a local councillor. On Sunday afternoons, our neighbours would sit at the kitchen counter working through problems for their kids, their health and local parks and streams.
None of the things people would visit to talk about have a natural end point. They were about child poverty, the degradation of the environment, or the need for better healthcare — and the complex interactions between these issues. I got into politics to work through those issues for people too, because whatever progress we have made in the last two decades, the job isn’t done.
These points are worth bearing in mind following the Government’s recent announcement of nine public service targets.
Targets in themselves are not a bad thing. In Government, Labour set a range of targets to ensure that progress towards long-term measures was being tracked. The Public Finance Act was reformed to require government to set wellbeing objectives and state how Budget decisions have been driven by these objectives.
But when are targets a useful tool for accountability and when are they counter-productive? The British economist Charles Goodhart coined what is known as Goodhart’s law: “When a measure becomes a target, it ceases to be a good measure.” When we put too much weight on a single indicator, that becomes a less reliable measure of the outcomes that we care about.
Take the targets National has set for the health system.
Targets have a long history in the United Kingdom’s national health service as a way of trying to change behaviours within a system.
Ideally this works through directing energy towards things that matter. But poorly implemented targets can result in gaming of the system or neglect of aspects that aren’t measured.
As Labour’s health spokeswoman Ayesha Verrall said, effective targets need to be focused on the relevant part of the system, with a clear timeframe for achieving them.
National has set a target for patients to receive cancer management within 31 days of the decision to treat. However, if the barriers to treatment are actually the long wait before patients can get the biopsies and scans that would lead to that decision, then the targets are focused on the wrong part of the system.
National’s targets also completely ignore primary care doctors, GPs, like my mum. One of the biggest problems in health is that people can’t see a GP, but National has no target that would see GPs remunerated fairly, supported to do their work or to support training of the workforce. There are no targets for other primary health outcomes, like kids’ teeth, that would support early intervention.
In government, Labour set measures and targets for reducing child poverty across a range of measures through the Child Poverty Reduction Act and took meaningful action to meet these targets.
Despite severe global economic conditions, Labour oversaw 77,000 fewer children living in low-income households and the reduction of all nine child poverty measures.
We need sustained investment to continue making progress on this issue. National voted for the Child Poverty Reduction Act. However, the existence of these targets has not stopped the ruling party from taking steps to actively make these measures worse.
National’s decision to return the indexation of main benefits to inflation rather than average wages will result in child poverty increasing by an estimated 7000 children by 2028 on both the main income poverty measures.
Labour also worked to deliver the Zero Carbon Act in 2019 — with a target of net zero carbon emissions by 2050. The Government delivered carbon budgets, an emissions reduction plan, and a Climate Commission to guide the process. Business was on board, and the primary sector was working hard on a shared set of goals — and it made a difference.
As at the end of 2023, emissions had fallen for three consecutive years; New Zealand was on track to meet its first emissions budget.
Again, National supported these targets. But its actions to date have been to scrap successful climate programmes already bringing down emissions.
Done well, targets can ensure accountability and support a longterm approach on difficult issues. But National’s actions are not consistent with the existing targets that it had signed up to.
National’s public sector targets are coming as it takes an axe to the public sector. The party’s neglect for the health of the system is evident in the list of programmes that have already been put at risk — disability allowances, healthy school lunches and the Suicide Prevention Office.
Given this context of cuts, there is every reason to believe National’s targets will either not be met — or they will be met in ways that undermine the outcomes that Kiwis care about.