The case against a target culture: In Finland no targets = higher quality provision..could this be the change we need in the NHS ?

Finlands education system is one of the best in the world, and it does not rely on targets and league tables.  Could this show us a way forward to making improvements across the public sector from education to health and social care?

With both  Jeremy Hunt and Andy Burnham acknowledging a target culture within the NHS contributed to the failings in care at Mid Staffordshire Hospital and Nicholson suggesting to the Select Committee there was to much focus on ‘systems’ now might be a good time to take a different approach.  Of course the coalition has already suggested a change in approach with the introduction of an ‘outcomes focus’.  My concern is an ‘outcome’ could become the new ‘performance indicator’, where ticking a box to verify you have met it overshadows assessing the actual quality of the outcome.

So how do we turn the system around?  Well I wonder if the answer lies in Finland.  An interesting article , about the education system in Finland, caught my eye this week and got me thinking.  Apparently Finland’s education system is the best in the world, although this has not always been the case.  Following failure in the 1970′s the whole system was reformed, and the reforms seemed to have worked, and even cost less than when the education system was failing.

So what did they do? Introduce targets, performance indicators, outcomes, privatise the system to increase competition and consumer choice to drive up educational standards? Well, no, just the opposite really.

Firstly, there are no league tables in Finland, the main driver of education policy is a vision focused on ensuring all children have access to the same opportunities to learn in a good school, wherever the child lives and regardless of the childs economic background.  Cooperation between schools rather than competition underpins this ethos, as does a belief in the ability of individual schools to achieve this without centralised targets from government or regulation.   Teachers are valued as professionals and as such are trusted to assess children in their classroom using independent tests they create themselves.  If they do not feel it is beneficial to the childs well-being they do not test the child. Inclusion in tests are determined by whether it positively affects the students learning, not whether it increases students scores or meets a performance indicator.

The bit that really caught my imaginaton when reading was when the interviewer asked about the accountability of the teachers and those who run the school.

‘Salberg shrugs. “There’s no word for accountability in Finnish” later on suggesting “Accountability is something that is left when responsibility has been subtracted”

Whether this is true or not I do not know as I do not speak Finnish, however, it is an interesting notion that by acting responsibly accountability is not an issue.  In Finland teaching professionals are afforded prestige, decent pay, and a lot of responsibility, which they evidently fulfil with gusto.  So the question of ‘accountability’ seldom arises. If it does it is dealt with by the head locally.

And believe it or not but all of this has been achieved by not privatising education, that’s right not privatising education.  There are no private schools in Finland, only a small number of independent schools exist in Finland but even these are publicly funded. None are allowed to charge fees, and there are no private universities either.  The focus in public sector provision of education is on equity and shared responsibility, not choice and competition. Hmm can we learn anything from this in light of recent events at Mid Staffs, and beyond?  Targets and performance indicators in health and social care seem, to me, to have had a demotivating affect and enabled organisations to somehow relinquish responsibility for their actions, at both a corporate and individual level, because on paper they have supposedly met a target.

How do I imagine the health and social care system of the future? Hmm…Imagine being a patient and not fearing going into hospital.  Imagine being a family member and not fearing what might happen to your loved one.  Imagine a health and social care system where everyone within those organisations sought to fulfil their responsibility to provide the best care possible for those who used their services without meeting targets and PI’s, imagine government communicating a clear vision of the value health and social care adds to the life of this country, imagine being valued and respected by government and society as an employee in health and social care, most of all imagine being trusted to take a lead in the development of the best publicly funded system of health and social care in the world, imagine!

At present public trust and confidence in the public sector must be at an all time low, however, this provides us with an opportunity for real change, a change in direction that is not political or ideological.  One of Finlands key success factors has been a recognition that learning from past experiences can build a better future.  Can we do the same?

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