The Royal Pharmaceutical Society’s chief scientist Jayne Lawrence gave an interview on the BBC on Wednesday 5th November arguing that doctors needed ‘binding targets’ to reduce the over-prescription of antibiotics. Despite the fact that everyone knows we are becoming resistant to antibiotics, including and especially doctors, still the amount of antibiotics prescribed has risen rather than fallen both in the UK and across the world. It was unclear from the interview with the BBC journalist exactly how these binding targets would work – and Dr Lawrence was taxed on this very point by the interviewer. What happens when the annual target for prescribing antibiotics has been reached and yet there are more patients who need them? However, one of key her arguments was that targets help GPs keep the issue ‘in mind’.
This is a good example of what has become an accepted response to a general, population-wide problems. It has become taken for granted that the first recourse must be to set a target and preferably to make it binding. So we have the Millennium Development Goals (MDGs) for social development in developing countries, global emissions targets which are binding depending on whether a particular country has signed up to the Kyoto protocols or not, and a variety of targets for the NHS, Education and schools in the UK with more on the way (the Deputy Prime Minister Nick Clegg has just announced forthcoming waiting time targets for mental health patients). These are then backed up by apparatuses for scrutiny and control so that the targets can be enforced and made ‘binding’.
On this blog I have posted a variety of articles here, here and here where I have suggested that setting targets has become axiomatic in organizational contexts as a way of declaring seriousness of intent and sometimes moral purpose; as a way of exercising disciplinary control by ‘naming and shaming’, including and excluding when targets are taken up as cult values; and as an authoritarian theory of motivation (that staff in organizations will not do things unless they are forced to do them and then inspected to make sure that they really have). Continue reading