By remarkable coincidence two institutions which are pillars of British identity are being subjected to unprecedented public criticism at the same moment.
The ignominy into which they have suddenly fallen seems to be in direct proportion to the reverence in which they were once held. So it might pay to ask what the British Broadcasting Corporation and the National Health Service have in common, apart from the fact they are both universally referred to by their initials. Note: this point about initials is significant.
Referring to the “BBC” and the “NHS” is so well established that even official news coverage which is usually punctilious about such things, does not generally bother with the full titles.
What it suggests is a kind of affectionate familiarity on which everyone agrees – like a pet name for a family friend with whom relations are so close that no formality is required. So there is clearly something about these organisations that sets them apart from other agencies which offer services to the public.
They are not just, respectively, a broadcasting company and a healthcare provider. Indeed, they always choose to present themselves as fixtures of society which belong to the nation as a whole: “our NHS” and “your BBC”.
It is significant that they both emerged in their present form during the postwar era in which communality and collective purpose were seen as the bonds which had enabled the country to triumph over adversity. On this assumption, to question the models of national broadcasting and national healthcare would seem like trampling on the most sacred pieties of the British spirit – hence the description of the NHS as a national religion.
In spite of all the criticism and popular frustration, there is still something compelling in this picture: the idea that broadcasting (particularly the dissemination of news) and the provision of medical treatment should belong to the people as a whole rather than to private interests or individuals has a considerable moral force.
What is becoming clear in the latest eruptions of public anger is a sense that it is precisely that principle that has been betrayed. Nothing has done more damage to the standing of the BBC, for example, than the sense that it is a self-regarding and self-preserving club which regards public opinion with contempt. Fury over the hapless incompetence of NHS management and the activist militancy of its staff has induced a sense of abandonment and betrayal of the patients who should be its first responsibility.
Perhaps the most important thing to note about the old conception of these institutions is that even in its most attractive form – uniting the nation in a mutual sense of mission – it is ideological. Judgements about the organisation of broadcasting and medical care are based on a political idea of what makes a good society rather than on the quality of the services they are providing.
It is often said that even if some instruments of private finance for medical treatment offer better outcomes, they would be unacceptable because they could create a “two tier” health system with some people getting advantages that others do not.
Even if you agree with that view, you must accept that it is a political judgement, not a medical one: it makes equality of distribution rather than quality of treatment the first priority of the healthcare system.
The evidence from other countries which accept mixed private-public health financing is overwhelmingly convincing: patient outcomes and satisfaction are both higher than they are in the UK. The management discipline of the private sector combined with the degree of consumer choice which it offers, creates a patient-centred culture which it has been impossible to replicate in the British system. Attempts to do so, like the Tories’ “internal market” which was supposed to mimic the competition of real market forces failed precisely because it was a sham.
The NHS distribution model springs from the same mentality as wartime food rationing which did not come to an end until 1954. The excuse for its persistence nearly a decade after the war ended was that without state-enforced limits on individual consumption to guarantee fairness, there would be shortages which would inevitably favour the better off and thus create inequality. What actually happened when rationing ended was that the market responded to demand by increasing supply. That is what real markets do.
And that is exactly what the open market in broadcasting is doing to the logic of the BBC’s remit. The availability of genuine competition for audience and influence has turned its role as universal voice of the nation into an absurd presumption – and the sublime arrogance with which it has floated through a series of horrendous scandals just adds to the impression of being out of touch.
The Corporation is responding to the new competitive world in which it finds itself in the worst possible way: it manages to be disdainful and defensive in equal measure. (Full disclosure: I worked as a broadcaster for Radio4 for ten years and can testify that the BBC treated me with more indifference, callousness and outright nastiness than any newspaper which has ever employed me.)
Not only is the country growing accustomed to choice – and the power that it brings – in its broadcast programming but it is happily widening the means by which media products are consumed. What used to be monolithic network television and radio is now competing with streaming, podcasting and on-demand availability.
So there is no going back for the BBC. But the wider spectrum of choice in the new technologies from broadband to smart phones and the courting of consumers that follows from it, is spreading an idea which state-run, producer-dominated services simply cannot match.
The NHS too is holding out against an inexorable shift in public expectation in which services are judged by their productiveness and fitness for purpose. What people want now from their healthcare system is what they get from efficient competing service providers: prompt, considerate, responsive attention with respect for their individual needs. There is no way that a state monopoly can achieve that.
