I watched Shadowlands again the other day, Richard Attenborough’s film about C.S. Lewis’s relationship with Joy Gresham, and was struck by one scene in particular. Anthony Hopkins is sitting beside the hospital bed of Debra Winger when suddenly she takes a turn for the worse. He leaps from his chair and runs out into the corridor. ‘Nurse, Nurse!’ he cries and almost instantly a nurse comes running and darts into his wife’s room. Shortly afterwards, a doctor appears and he updates Hopkins on Winger’s condition in a tactful, solicitous manner.
For any middle-class person who’s spent time in a hospital recently, this seems laughably out of date. Apparently, there really was a time, not so long ago, in which the social hierarchy of modern Britain was preserved in the NHS. If you were a professional person of some standing — an Oxford don, say — nurses would show you a good deal of respect. Even more remarkably, you could expect doctors to treat you as an equal. Incredible, but true.
To give you some idea of just how things have changed, consider a recent trip I made to visit a friend in hospital. He was semi- conscious and hooked up to a drip, having just come out of surgery. Various bits of detritus were strewn across his bed — a half-eaten sandwich, a banana skin, an old newspaper — as if someone had tipped up a wastepaper basket. When I pressed the button to summon a nurse, a short-tempered woman appeared and explained that the button should only be used in case of emergencies. Later, a consultant came by and, speaking very slowly and loudly, told my friend the operation had been a success. ‘You get better now,’ he said, smiling and nodding as if addressing an educationally sub-normal child. I didn’t have the heart to tell him that my friend had recently been appointed a British ambassador.
I’m not suggesting that the level of service you receive in the NHS should be dictated by your social class. In an ideal world, everyone would be shown the same courtesy as Anthony Hopkins in Shadowlands. But it is a particular shock to discover that as a user of the NHS you occupy the same status as an untouchable in 19th-century India. Even the wretched lumpenproles who hand out the slops — the ‘catering assistants’ — are higher up the pecking order.
It’s not just NHS staff who are guilty of treating people as barely tolerated irritants. The attitude you encounter — bored, impatient, a sense that the person would rather be anywhere else — is typical of the way all public sector employees treat their ‘clients’. Earlier this week, I managed to buttonhole my postman and asked if there was any chance he could retrieve something for me from the depot. (I was clutching one of those ‘Sorry, you were out’ cards.) ‘Nah,’ he said, shaking his head. That was it. No apology, no explanation — just ‘Nah’.
Some people would blame this rudeness on the poisonous legacy of the English class system. Any sign of deference might be mistaken for a bit of old-fashioned forelock-tugging and is therefore avoided like the plague. That is the general explanation for why service personnel are so much more polite in America than they are here. But in fact you encounter exactly the same attitude among civil servants in America, too, as anyone who’s been through immigration at JFK can tell you. Indeed, it will be familiar to any person who has ever had an encounter with a state employee whose job involves dealing with the public, no matter where they live.
The problem does not lie with the sort of people who take up these low-level public sector jobs, but with the nature of the relationship between the state and its citizens. Ninety-nine times out of a hundred, the ‘end user’ will be asking the state employee for some sort of handout, whether a 90-day visa waiver or free medical attention. That places the employee in a position of power over the petitioner and, human nature being what it is, that inevitably leads to contempt.
George Orwell got it wrong. The relationship between ordinary people and the all-powerful nation states that have come to define the modern era is not that of a boot stamping on a human face. Rather, it is of a hand being held up, palm outwards, as if to say to the human face, ‘I’m just not interested.’
Toby Young is associate editor of The Spectator.