What the NHS and royal crises in the UK have in common

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No US president since George Washington has made a profounder farewell address. In place of bland self-praise — so many jobs created, so much national pride restored — Dwight Eisenhower set out an argument. Institutions, he said, even those conceived for the public good, even the army he once led, seek to enrich and aggrandise themselves. Patriotic voters may find that self-interest hard to credit. The institutions themselves may be unconscious of it. But it is real and distorts national life. Ike’s “military-industrial complex” is a famous coinage. He worried no less about a “scientific-technological elite”.

As a call to vigilance, the speech failed. So did the public choice theorists who made the same warning in more academic form as state bureaucracies grew after the war. In the US, the military is among the most trusted bodies and Congress the least. In the UK, if you want loud and cheap applause, say that politicians are in it for themselves while “key workers” offer disinterested public service.

Look around. The two big stories in Britain today have a linking theme, and it is institutional self-interest. Or rather the public’s denial of it. Of all the problems with the NHS, resistance to reform among some in the workforce is the hardest to discuss with voters. Politicians know the score — even Labour’s Wes Streeting wants to change the terms on which general practitioners work — but have to walk on eggshells.

And this represents progress. The last two times the government changed (1997 and 2010), incoming ministers trusted the “public service ethos” to secure much of the desired improvement in healthcare. In both cases, it became unignorable after a while that NHS staff had worldlier motives, too. In both cases, a programme of efficiency reforms followed. In both cases, the medical-bureaucratic complex fought back. The initial naïveté of ministers would have been unforgivable if the voters they answered to hadn’t shared it.

The NHS’s one rival for media coverage right now is the royal tiff between London and Santa Barbara. It has none of the life-and-death stakes. But it does have a similar shape. There is the same attempt to show that an institution with no profit motive can still be self-interested. There is the same widespread resistance to the very notion. Prince Harry’s memoirs do not say that his estranged relatives are sinister or more dysfunctional than the next family. Rather, he paints the Firm as just another organisation: as strategic as a corporation, as media-literate as a trade union, as keen on its own survival as a quango. The line of attack is all the more interesting and plausible for being the lesser one. To go by the national polls, though, even this has failed to land. Had the government been the target, he’d be feted.

If the British are more precious than most about their institutions, I offer a theory why. All western societies have more or less the same capacity for deference. They only differ in exactly where it is channelled. The way of the UK has been to cock a snook at elected office-holders. This Swiftian impudence has its uses. It helped to inoculate the body politic against the dictatorships that marred much of Europe in the last century. But we aren’t nihilists in this country. That human need to defer has to go somewhere. And it goes to institutions: the “National Health”, the royals, the BBC, the armed forces, the judicial bench, the National Trust even. (Brits, accused of worshipping the NHS as a religion, are in fact polytheists.)

We cringe at the unsmiling grandeur around the US presidency, then, and at the Jupiterian airs of the French one. We can see how such deference contains the potential for a dangerous “republican monarchy”. Perhaps it is wiser to revere one family that is invested with little formal power. But to beatify a system of healthcare? To call a civil service “Rolls-Royce” in the absence of much evidence? To give the moral benefit of the doubt to almost any entity that isn’t commercial or political? Some of these institutions have tens of millions of lives and livelihoods in their hands. It shouldn’t feel as subversive as it does to cheek them.

Populists have given vigilance to authority a bad name. When the likes of Liz Truss and Dominic Cummings defied this fiscal watchdog or that branch of Whitehall, it was right to mount a defence of “institutions” in the abstract. But defence can cross into outright indulgence. Institutions have rational interests: in less rather than more change, in better rather than worse terms, in greater rather than weaker clout. The ultimate establishment president had a point. It doesn’t become less true in the loud mouths of demagogues.

janan.ganesh@ft.com

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