One of the woeful inadequacies of public debate in the media is the failure to make connections. With a bevy of specialists and experts on every conceivable subject at their beck and call, if any of these people so much as hint at a link with another issue, the Jeremy Paxmans of this world cut them off and steer them back to the matter in hand. This refusal to relate is in contrast to our daily experience, where it is not difficult to see how the same policies in areas as different as health care, education, public transport and broadcasting inexorably yield the same results.
On the night the Conservative Party lost Christchurch to the Liberal Democrats in the largest swing against the Tories this century, I took someone to St. Thomas’s Hospital Casualty Department for treatment of a minor and found that we had to wait nigh on six hours before she was attended to. The hospital staff told us this is now a common experience in London casualty departments, and that the situation at St. Thomas’s has worsened since the closure of the casualty department at Westminster Hospital across the river, because St. Thomas’s now receives more patients at night with no increase in staff. There were two doctors on duty and the sister thought the optimum for the department should be four. Naturally, since my friend’s injury was minor, she had to wait for attention rather longer than more serious cases; and of course children are always seen before adults. But there were plenty of other people growing impatient too.
One of the nurses actually told us it was like living in a soap opera. The cast of extras in this particular episode included an amiable and rather drunk Irishman with a large red bump on his forehead; a Middle-Eastern kitchen worker brought in by a chef after an argument with another worker in which a couple of his fingers got cut; two lots of parents bringing children with illnesses; another child with a cut on his head. More than half the patients at this major inner city hospital were black or belonged to ethnic minorities.
A notice on the wall in the waiting area, signed by the Chief Executive of the Hospital Trust and commenting on the pending merger between St. Thomas’s and Guy’s declared that ‘The excellent accessibility of both St. Thomas’s and Guy’s for the population of London and the Southern Counties makes any distinction between the two sites on the grounds of patient convenience unimportant.’ Oh? If the comfort of the patient is no longer the first priority, in that case, what is? Why is it that despite everything we are told about increased expenditure on the National Health Service and the efficiency of the new regime of hospital trusts and the internal market, the quality of the service for the average punter is declining? And what is the real cost of this decline?
The news media report the most dramatic effects – when acts of violence, for example, are committed by schizophrenic patients who have been released into inadequate community care, or the case of the children murdered by a hospital nurse who was psychologically unfit to be working there – which raises questions about hospital management. Television soaps keep the drama of the hospitals constantly in the public eye. But who counts the cost of the mundane?
For example, having been up all night, I was in no fit state to work the following day. Most people coming to casualty for attention are accompanied by someone else, of whom a good proportion are not unemployed. How many days’ work is lost through the inability of our hospitals to cope with patients in a reasonable amount of time? Not that these effects are always quantifiable. You cannot quantify the wear and tear on people’s nerves – or only in terms of the annual number of prescriptions of tranquillisers. In which case, you have to add the cost of treatment for the people (mostly women) who become addicted to them.
What is happening to the health service shows up the government’s simplistic comprehension of economics. In particular, it seems to have no grasp whatsoever of the value of investment in infrastructures like the health service or education or public transport which keep the whole society going, services which cannot possibly be provided by private operators with anything like the same equality of provision as the public sector, nor as efficiently.
Why does the government think that the opposite is true? Why does it believe that private firms, each one eating up its own administration costs, raking off a profit from its activities and keeping wages down, are a more effective or desirable form of organisation? And why doesn’t it come clean on the cost of introducing and regulating all these schemes for deregulation and privatisation? For while the government is now considering slimming down the civil service by contracting out, the reason given by Peter Brooke a few weeks ago for not requiring the Arts Council to do the same was that it would cost too much.
The same questions need to be directed to John Birt and Co., because you can see exactly what these policies entail in the Corporation’s current crisis. How can the organisation of the BBC be improved, asks the government’s Green Paper? Facing the renewal of its Charter in 1996, the BBC asks itself what it is politically correct to do and comes up own special version of PC – Producer Choice. Producer Choice is the BBC’s interpretation of the internal market, the doctrine which says that everything in an enterprise must be internally costed.
It is being said that this is a moment of truth for BBC management because until now nobody has ever really known how much its programmes cost to make. True, but there was a conventional accountant’s method of dealing with this: the distinction between above-the-line costs – actual expenditure in cash – and those below-the-line-jobs and services provided internally and paid for centrally. What almost nobody says (though Mark Tully last July hinted at it) is that there were perfectly good reasons for operating this way. Good programme-making is supported by a large and diverse range of services, from libraries to graphic departments. How can it be sensible to charge producers for facilities whose provision involves minimal above-the-line expenditure, such as the use of sound and picture archives? One report says that the Record Library now charges so much for borrowing records that producers often find it cheaper to buy them instead, ‘and if a record is popular, 20 different departments or stations now purchase their own copy – a method of money-saving which Lewis Caroll would have adored’ (Anne Karpf, ‘Welcome to Wonderland’, Guardian, 19 Jul 93). In short, Producer Choice represents a radical failure on the part of BBC management to understand the real value of its infrastructure, or even the meaning of the word: support from below (instead of orders from above).
For ‘creatives’ – as advertising calls them – to work efficiently, happily, productively and indeed creatively, it is best to leave them in charge of their own allocation of time on the multiple highly skilled tasks they perform, unburdened by the need to keep logging what they’re doing which only wastes their time. Worse still, arbitrary and uncompetitive charges are being attached to facilities where the producer has no choice, like the rent charged for offices when the BBC owns the freehold. The reason for these charges is not the cost of support but that of the superstructure. The problem is that the BBC is top-heavy and management has to be paid for. Plus the hundreds of thousands of pounds spent on refurbishing Marylebone High Street for management propaganda sessions. And a reported £40m (!) lavished on management consultants (who probably advised them to do it) and who knows what else?
The cult of management expertise belittles the knowledge of those who do the job. A BBC producer who wishes to remain anonymous writes: ‘The costs of this approach are enormous. The market ideology espoused by BBC top management has been tried in the USA and found wanting. Loyalty and commitment are a two-way street. In the week horribilis in July when the BBC’s own survey reported that BBC employees fearful of speaking out, the Economist attacked the flaws in the philosophy Birt and Co have swallowed: “In the workplace of the future,” it concluded, “the fiercest competition may not be for customers, but for the hearts and minds of employees”.’
These issues go deeper. The most bizarre political event of the summer was not the government’s contortions over Maastricht but the response of the police, finally threatened with the same fate as every other social and public service since 1979, to new proposals for a management revolution in the police force. A mass meeting at Wembley heard what nobody in almost 15 years has said so clearly. I find it funny to be agreeing with the police, but they’re right: policing is not the kind of work you can subject to the criteria of cost-effective management techniques. The criteria are social, not economic. A few days later the Lord Chief Justice repudiated government plans for reform of the judicial system, including restriction of the right to trial by jury. Freedom, he said, is not compatible with cost-cutting. He is most certainly right.
The police are protesting because policing, they say, is not like any other job. But nor is that of the doctor, the nurse, the teacher – or the broadcaster. All are devoted – or should be – to ends which are not compatible with a cost-cutting mentality – while the costs of mismanagement are not just economic but also social, cultural, and political. Thatcherism proclaimed an end to the role of the state on the grounds of its costliness. One thing is certain: with all its monetary mistakes, this government is costing too much.
But instead of making these connections, the media succour a tendency to speak about themselves in large political metaphors which sound ominous but only serve as smoke screens. In the case of the BBC it started last summer with Michael Grade calling Birt a Leninist, on account of his secretive centralism (as if the BBC hasn’t been like that since Reith first knocked it into shape at the end of the 20s). Now he is being called a Stalinist, or at least, said Mark Tully, ‘so many managers parrot his name that many of the staff feel there is some sort of Big Brother watching them’ (‘Birt’s BBC is “run by fear”’, Independent on Sunday, 11 Jul 93, p. 1). These attributions are at best confusing and diversionary. Forgive me for asking, but in this world, where Stalinism and newspeak equal latter-day Thatcherism, who are the independents who are going to come riding to the rescue?