Health targets in the NHS: lessons learned from experience with breast feeding targets in scotland

Abstract

Goal and target setting is a basic precondition to effective management and the basis for accountability for both the use of health services and for achieving health care outcomes 1 Target setting has long been seen within business as an essential part of formulating any strategy. Targets should be related to actions known to be effective, be achievable but challenging, and be able to be monitored through indicators (see box).2 Targets can highlight key aspects of policy and act as a stimulus to increase commitment to policy implementation. Careless target setting, however, based on inadequate data or unrealistic short term objectives, can be counterproductive in that the resulting targets may discourage action and place unnecessary stress on those expected to achieve them. [3][4][5] The publication of the consultative documents The Health of the Nation in 1991 and Scotland's Health: A Challenge To Us All in 1992 heralded a new government approach to health planning, central to which was a need to identify clear objectives and specific targets for improving health.6 7 These targets were to be identified in each of the key areas of greatest health concern and where the greatest opportunity for real improvements in health could be realised. Their main aim is to stimulate and direct coordinated action. 6 Although it was envisaged that the results of target setting would be assessed, no published reports have looked at the results of target setting for health in the UK. A number of key questions posed in the BMJ five years ago are still unanswered: Do targets inspire, motivate and encourage coordination and common purpose among health workers and organisations?Can they engage other sectors at local and national level?Will they mobilise support from ordinary people and communities? 8 In this article we take the opportunity provided by the recent adoption of breast feeding targets by all Scottish health boards to look at one example of target setting in the NHS in Scotland. Breast feeding targetsIn 1993 the national review of food and nutrition in Scotland recommended the adoption of targets for breast feeding, 9 and in November 1994 the Secretary of State for Scotland announced a national target: more than 50% of women to be still breast feeding their babies at six weeks of life by the year 2005 (an annual increase of 1.3% in the percentage of mothers breast feeding every year from 1990). The Management Executive of the NHS in Scotland reinforced this by asking all health board general managers to advise them of proposals for local breast feeding targets and milestones in line with local circumstances by January 1995. 10The case for setting breast feeding targets in Scotland is well founded: breast feeding rates are the second lowest in Europe and among the lowest in the world.11 There is good evidence that raising these rates would improve health in children by preventing diarrhoeal episodes [12][13][14] and reducing the numbers of cases of lower respiratory infection, 14 15 necrotising Health targets: desira...

Painting by numbers: A guide for systematically developing indicators of performance at any level of health care

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Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study

“…As the method of infant feeding has short-and longterm health implications for both infant and mother, the aim of public health policies is to increase rates of breastfeeding initiation and duration (1)(2)(3). Many women in the developed countries initiate breastfeeding but stop within the first few weeks or months (4).…”

A stakeholder analysis of the perceived outcomes of developing and implementing England’s obesity strategy 2008–2011

“…A third insight from these interviews is the perception that setting targets and having a means of monitoring them provided a strong incentive for government stakeholders to implement actions to address obesity. While health targets have been shown to be problematic when they place unrealistic demands on implementers [ 32 , 33 ], interviewees in this study thought that targets were helpful in stimulating action. The target and the monitoring programme appeared to provide England with a system of public accountability for childhood obesity (which the current government has opted to continue, despite considerable changes in public health since the Strategy).…”