Professor Christopher Hood, an expert on public service management and others have pointed to ‘gaming’ of targets as a significant problem. Bevan and Hood, for example point out in Have targets improved performance in the English NHS? that efforts to meet targets can lead to perverse outcomes. For example, in 2005 in order to meet a target that 100% of patients be offered an appointment to see a general practitioner within two working days many GPs had stopped booking appointments more than two or three working days in advance.

Hood identifies in Targetworld: The Targets Approach to Managing British Public Services that gaming can take three forms:

·        The ratchet effect: whereby managers curtail performance below potential in order to be sure to meet targets in subsequent years (which they anticipate will rise incrementally);

·        The threshold effect: whereby uniform targets do not encourage excellence from top performers but may incentivise managers to reduce their performance to just meet the target;

·        Hitting the target missing the point: where outputs are distorted or results are manipulated.

Ultimately due to gaming the public and government are unable to determine the difference between the following four outcomes:

·        ‘All is well; performance has been exactly as desired in all domains (whether measured or not);

·        The organisation’s performance has been as desired where performance was measured but at the expense of unacceptably poor performance in the domains where performance was not measured;

·        Although reported performance against targets seems to be fine, actions have been at variance with the substantive goals behind those targets (hitting the target and missing the point);

·        Targets have not been met, but this has been concealed by ambiguity in the way data are reported or outright fabrication.’