Managers set targets and demand reports. Reports show targets are being met. All is well. Or is it?

In defence of targets ministers point to reductions in waiting times and time waiting in A and E. Did things improve? Or did people cheat? In the NHS they refer to cheating as gaming. In how many ways did NHS staff use their ingenuity to be seen to be achieving targets?

As Deming would often say: ‘If you improved by 20% this year, what were you doing last year?’ Improvement is about method; targets can only get in the way.