SPECIVOR
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THE BRITISH DISEASE
There is a prejudice in this country that any public servant who claims to work for the general welfare must actually contri- bute to it. Thus it was only to be expected that when two hospital groups announced 900 redundancies, there should be a public outcry. Yet there is no necessary connec- tion between the number of people em- ployed in health and welfare services and health and welfare themselves. Japan has the highest life expectancy in the world, and the lowest infant mortality rate; yet it has far fewer doctors and health workers than many highly developed countries, including Great Britain. The Soviet Union has a higher proportion of doctors to population than any country in the world except Israel, yet the health of the Soviet population is worse than Mexico's or Chile's. The United States spends more than four times as much per head on health as Great Britain, and Germany twice as much, yet their statistical indicators of health are, if anything, slightly worse.
The Health Service unions are anxious to preserve the jobs of their members. It is natural that they should seek to portray the redundant workers as essential to patient care, and raise the spectre of abandoned or unattended sick. But an increasing propor- tion of the Health Service's labour force has nothing to do with patients; there are nurses who do not nurse and managers who do not manage, there are accountants, security men, fire officers, counsellors, computer operators, careers advisors, spe- cialists in pension schemes, filing clerks and hosts of other bureaucrats, whose contribution to the health of the nation is expensive but slight. At the inception of the Health Service, the wage bill was 50 per cent of its total cost; it is now nearly 80 per cent.
The reforms in the Health Service, Which have led to the present redundan- cies, are an attempt to introduce a sembl- ance of financial accountability. It is to this Principle that so many workers, with much to hide, and who would long since have been dismissed from any private employ- ment, object. It will no longer be sufficient for them to surround themselves with the general aura of benevolence and usefulness Which has hitherto protected them: they Will have to prove their worth. There are undoubtedly dangers in such sweeping reforms. Previous attempts have always resulted in more, not less, bureaucracy. The wisdom of introducing such reforms nation-wide, without pre- vious trial, may be questioned. The de- mand for accountability might itself turn into a bureaucrat's charter. But the princi- ple of demanding value for money is sound, especially in a service with an inherent tendency to exponential growth in costs.
Low-paid workers in the public sector (in part low-paid because there are so many of them) have a powerful vested interest in preventing improvements in efficiency. This explains why public sector unions, which speak the language of de- dication to public service, are so inimical to the public interest and why they are so opposed to public accountability in schools, hospitals and so forth. They de- pend for their power upon the existence of an inefficient, low-paid and unskilled workforce, and nothing would be a greater disaster for them than a workforce that was highly skilled, well-paid and contented.
The universal shabbiness of British pub- lic institutions (our hospitals are filthy, despite shoals of cleaners) is a direct consequence of their propensity to over- employ, a covert form of social security. Where new technology is introduced, it adds to capital expenditure without reduc- ing labour costs, and workers without work are shifted elsewhere.
Two lamentably British attitudes under- lie the problem. The first is that public service, or rather employment in the public service, is meritorious in itself. This is allied to a snobbish disdain for commercial values: public employees no more enquire after the origin of their income than characters in Jane Austen. But the receipt of wages, however low, from the public exchequer in return for labour of no value is no more moral, and is less socially useful, than a fortune made in coffee futures. The only firm foundation for good public services is a thriving industry and commerce.
The other attitude that bedevils British public services is fear of the future. Innova- tion is fought rather than embraced. Change is never seen as challenge, only as threat, and redundancy is therefore im- agined as permanent unemployment. Learning is not considered an appropriate response to redundancy.
This is why our public institutions strike foreigners as belonging more to the Third World than to an advanced industrial nation. 'We pretend to work and they pretend to pay us' is a system which suits too many workers in the public service. Lacking the skills with which to face a changing world, they fight for stagnation. Until we have a flexible and educated workforce that accepts change as natural and even welcome, we must expect our public services to be as much concerned with employing the otherwise unemploy- able as with serving the public.
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