This paper examines problems of setting targets for health care performance in which the centre sets a uniform set of targets and levels of performance. The case study examined by the paper is from the system of performance assessment of ‘star ratings’ that was introduced from 2001 by the Department of Health to give each organisation in the NHS in England a single summary score from zero rating to three stars. Star ratings were directed at holding trusts' chief executives to account for the local delivery of national priorities through a process of ‘naming and shaming’, in which Chief Executives of zero-rated organisations were at risk of losing their jobs. This paper outlines the underlying model and its three underlying assumptions: the centre can determine a scoring system to prioritise what matters; failures of performance that are not reflected in the scoring system do not matter; and the advantages of a system of scoring on accountable targets outweigh the disadvantages of various types of gaming responses. This paper examines the application of the model of star ratings to a case study of Primary Care Trusts (PCTs), which are complex organisations with three diverse sets of responsibilities: delivering primary care, commissioning secondary care, and supervising public health. It outlines an alternative model and the issues this raises for governance of health care performance.

The setting and use of targets in the public sector has generated a growing amount of interest in the UK. This has occurred at a time when more analysts and policymakers are grasping the nettle of measuring performance in and of the public sector. We outline a typology of performance indicators and a set of desiderata. We compare the outcome of a performance management system — star ratings for acute hospital trusts in England — with a productivity measure analogous to those used in the analysis of the private sector. We find that the two are almost entirely unrelated. Although this may be the case for entirely proper reasons, it does raise questions as to the appropriateness of such indicators of performance, particularly over the long term.

The UK Government places ever-greater weight on performance assessment of local public bodies through comprehensive performance assessments (CPA). However, the CPA assessment framework has been criticised for its disregard of local factors that are beyond the control of local authorities but that affect their performance. In this article, the assessment framework is described and three different studies are appraised that have investigated the link between deprivation, as one of these external constraints, and CPA performance. Suggestions are developed as to how the analysis can be improved, by extending the choice of dependent variables and explanatory variables so as to be able to use panel data as the investigative method.

The performance of local tax offices of Norway is studied over a three-year period applying Data Envelopment Efficiency analysis and a Malmquist productivity index. The estimates are bias-corrected using a bootstrap approach recently developed for DEA models. The results show that bias correction and the construction of confidence intervals give a quite different picture without bootstrapping. A set of best practice offices is identified for future work on finding explanations for good performance. The productivity development of individual offices is classified into the four categories: productivity improving cost increase, productivity improving cost savings, productivity decreasing cost savings and productivity decreasing cost increase.