Quantifying, Economizing, and Marketizing: Democratizing the Social Sphere?

On 24 April 2007, the Daily Telegraph published the annual Dr Foster’s Good Hospital Guide in an article entitled “Lottery of death rates in hospitals”.  It came as a surprise to the Mid Staffordshire Hospital Trust that its Hospital Standardised Mortality Ratio (HSMR) was 127, as opposed to 114, and that it was ranked the fourth worst performing trust in the country on this metric. The abrupt change in the Trust figures had resulted in part from the recalculation of the national baseline figure, and some modifications to the methodology. There ensued much debate in both the media and in learned journals about the robustness of the results, the intricacies of the HSMR methodology, and the possible link between poor results and patient care.  There ensued also one of the biggest scandals in the history of the NHS, concerning the quality of care at Mid Staffordshire hospital. This resulted in a report by the Healthcare Commission, the body responsible for assessing standards of care in NHS hospitals, a subsequent non-statutory Inquiry commissioned by the Secretary of State, and finally a Public Inquiry which considered not only the care delivered but also the wider regulatory system.

Policymaking activities and administrative control are progressively structured around calculations such as cost-benefit analyses, estimates of social and financial returns, measures of performance and risk, ratings and rankings, all of which provide information in the form of a numerical representation. Through quantification, public services could be said to have experienced a fundamental transformation from “government by rules” to “governance by numbers”, with the aim of producing a self-regulating society. There are signs everywhere that this “quantitative turn” is making a profound impact on the way essential public services are organized, controlled and delivered. This quantification has fundamental implications not just for our understanding of the nature of public service itself, but also for wider debates about the nature of citizenship, democracy and the state, as well as for understandings of public administration.

This paper scrutinises the relationship between quantification, economization and democracy. The above example suggests that no technology or device is bad in and of itself, and that at least some of the devices that increasingly seek to quantify performance in contemporary societies may have a ‘democratizing’ ambition. Drawing on different empirical examples of quantification in the healthcare and correctional services in the UK, this paper pays attention to the labile nature of quantification and its relationship with processes of democratization and economization. First, we scrutinize what it means to “economize the social” and draw attention to three different aspects of economizing: the relationship between calculating and economizing; economization through marketization; and economizing as financializing. Second, we examine linkages between quantification, economization and democratization. Third, we consider the possible implications these developments have for our understanding of democracy, particularly with regard to the relationship between responsibility and accountability, the changing role of individual responsibility in quantified accountability regimes, and the consequences of such shifts for power relationships in contemporary societies.