Paper long abstract:

In the UK, practitioners in the National Health Service (the NHS) are increasingly subject to the requirements of performance targets and measures. In the area of mental health, these align with a larger policy focus on increasing patient access to psychological therapies. However, an increase in the expected numbers of patients being treated has not been matched with increased resources (other than in particular specialist services). In this paper, drawing on 40 interviews with clinical psychologists working in a range of settings across England and Scotland, I consider professional responses to new performance targets and measures. Departing from a conventionally evaluative idiom (i.e., are targets being met?), I consider targets as a kind of 'technology', enabling and propelling sociotechnical change within NHS organizations. This paper thus contributes to STS debates around the transformative effects of innovations, the governance of (health)care, and the links between epistemic practices and processes of subjectification. Specifically, it asks: what is it that targets do? I document three key effects. First, the production of anxiety about failures to meet targets, changing psychologists' relations with their work and hence with their patients. Second, the development and implementation of novel managerialist frameworks for assessing patient need and processing demand. Third, and most profoundly, the accommodation of performance measures into clinical practice in ways that rework the nature of therapy. This transforms the content and meaning of care practices in order to meet targets - and hence reshapes the kinds of subjectivities that are assembled through therapy.