The fashion for setting standards has touched the medical, as well as the teaching profession. We have been drawn to think about the implications of declaring "minimum standards" in the treatment of kidney disease, in particular. We have been impressed by the apparent confusion in the vocabulary of "targeting" and the lack of models in the processes of intervention. Our observations may be useful in education given the comments of Emma Houghton (27 February) and Judith Judd (20 March) in Education + on the National Literacy Project, ability ranges and targets.
The point of intervention in medicine or education seems to be the creation of a range or distribution of outcomes above a declared minimum, whether it be Level 4 for an 11-year-old or a dose of dialysis. In fact, the minimum is the lower margin of a desired out-turn of results, the mean/median and upper limit of which are uncertain at the start. Where resources are constrained and ability ranges have been defined it is not surprising that the only fixed element, the minimum, becomes the focus of attention. Unfortunately, because once achieved any effort for change will be diminished, the minimum tends to become a "ceiling" and the exercise is doomed to under-achievement systematically. It is interesting that it was said that "raising expectations ... gave teachers things to aim for". They have anyway the minimum to aim for, but this is apparently not enough. It seems that the intervention must be pitched to aspire well above any declared minimum, that is, the "aim" must exceed the "mark" systematically. Raising expectation is not just desirable, but essential to any successful model of intervention.
It seems that in literacy, as in some areas of medicine, a piecemeal, incremental approach to individual limits will be less effective, and ultimately more costly, than an unfettered population-based effort at a general elevation of achievement.
E.J. Will and C. Bartlett, Division of Renal and Liver Services, St. James's University Hospital, Leeds.
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