What's measured is what matters: Targets and gaming in the English public health care system

In the 2000s, governments in the UK, particularly in England, developed a system of governance of public services that combined targets with an element of terror. This has obvious parallels with the Soviet regime, which was initially successful but then collapsed. Assumptions underlying governance by targets represent synecdoche (taking a part to stand for a whole); and that problems of measurement and gaming do not matter. We examine the robustness of the regime of targets and terror to these assumptions using evidence from the English public health service on reported successes, problems of measurement, and gaming. Given this account, we consider the adequacy of current audit arrangements and ways of developing governance by targets in order to counter the problems we have identified.