I remember a manager in the hospital in which I worked before my retirement, with no medical or even nursing qualifications, prowling the wards to look for patients who could be hurried home so that beds would become available for patients who would otherwise break the government's four-hour rule, that is to say the rule that no patient should wait more than four hours after the decision to admit him had been taken. The concern that patients should not have to wait for more than four hours was not for their sake, of course, but merely so that the central government could claim that it was improving services, and so that the hospital could claim to have met its target. In the event the target was met by the simple expedient of redesignating hospital corridors as wards, satisfactory all round - except for the patients, of course. A healthcare system suffocated by bureaucrats, Theodore Dalrymple, 'Standpoint' (online only), Jan/FebThe well-being of a large, complex society, is inevitably going to mean giving priority to numerical indicators. In the absence of meaningful, broad indicators of well-being, we instead default to the targeting of deeply flawed accountancy measures (like Gross Domestic Product) and a plethora of meaningless micro-targets, like those about which Mr Dalrymple writes. It's not working.
A Social Policy Bond regime would bring some much-needed clarity to the hugely important task of defining, and prioritising, the essential elements of societal well-being. We could all participate in such an exercise. We all understand outcomes, and we can all have an opinion about which broad social and environmental outcomes are the most important to ourselves and society. That's a stark contrast with the current policymaking system, which in most countries is now largely under the control of the few interest groups who can afford to pay specialists to understand, manipulate and subvert the democratic process in their favour.