New Zealand’s Healthy Futures amendment has now commenced, adding timely access to quality services and requiring six health targets in the Government Policy Statement. Clear priorities can organise a stretched system. They can also distort it when the number becomes the destination rather than a signal.
The answer is not to abandon targets. It is to design them as a dashboard: several indicators, visible trade-offs, quality checks and explanations of who remains outside the frame.
What targets do well
A defined measure can expose delay, create common language and force leaders to explain performance. Stable publication lets the public see whether improvement survives beyond a press release.
The queue can move without the patient improving
A service may meet a time threshold by redirecting complex cases, changing classification or completing a low-value contact. Every access target needs outcome, safety and patient-experience companions.
Equity cannot be a footnote
National averages can improve while Māori, Pacific, rural, disabled or low-income patients wait longer. Results should be broken down carefully, with small-number privacy protected and action attached to disparities.
Staff need room to report pressure
Targets that feel punitive invite gaming and silence. Clinicians should be able to explain capacity, unsafe workarounds and unintended effects without being accused of opposing accountability.
Infrastructure and prevention matter
Hospitals cannot achieve durable flow if primary care, diagnostics, aged care, housing and transport fail. The amended Act’s infrastructure focus should include maintenance and workforce, not only new buildings.
Publish the balancing measures
For each target, report exclusions, denominator changes, readmission, harm, unmet need and survey evidence. Independent audit should test data definitions and revisions.
Use targets as questions
A missed target should prompt investigation; a met target should not end it. The important question is whether people received timely, appropriate care and whether the improvement can last.
Dashboards help drivers see. They do not choose the destination, repair the road or care for the passengers. Health policy should remember the distinction.
The denominator is political
Every target depends on who enters the measure. People who never reach a referral, leave a waiting list, cannot travel or are coded into an excluded category can disappear from apparent performance. Definitions and exclusions should be published with absolute counts, and any change in methodology should be shown as a break rather than a sudden improvement.
Unmet need deserves a place beside waiting time. A system may shorten the queue by making entry harder. Population surveys, primary-care referral experience and complaints can reveal demand that administrative hospital data never sees.
Targets need a learning response
Services that improve should describe the operational change: staffing patterns, diagnostic access, discharge coordination or prevention. That lets other regions judge transferability and prevents leaders claiming that pressure alone produced the result. Places that deteriorate need support to investigate rather than an incentive to recode.
Parliament and the public should receive a stable, independently assured series, while clinicians and communities participate in review. A dashboard is trustworthy when it makes bad news visible and useful. If it exists mainly to reward ministers, staff and patients will quickly learn to treat the numbers as performance theatre.
