The Hospital Without Patients
Jay, Jonathan Lynn and Antony
THE HOSPITAL WITHOUT PATIENTS A triumph of her majesty's civil service by Jonathan Lynn & Ant ony Jay Introduction by Leonard Reed 1 n 1985, WETA, Washington's public television station,...
...Well, Minister, I thought perhaps ...a retired civil servant ." I saw his point...
...And when we can afford it," I added sarcastically, "we'll open St...
...And take all those administrators with you," I added, waving in the direction of the good Mrs...
...Unfortunately," murmured Sir Humphrey, embarrassed, looking at his shoes, "he's also trying to work his peerage in his capacity as Chairman of the Joint Committee for the Resettlement of Refugees ?' I inquired if there were more Brownie points in refugees than in government inquiries...
...He said the unions wouldn't wear it...
...Humphrey had promised me that Williams was sound...
...I couldn't tell, as I read, if Humphrey was playing a practical joke...
...Number Ten hoped a peace formula could be found very soon...
...This man's double standards continue to amaze me...
...Rogers was unshakeable in her selfrighteousness...
...March 25th Today I paid an official visit to St...
...For instance, Hacker's party has come to power having pledged, among other things, to slim down the civil service...
...To concede a full independent inquiry...
...Thank God one of my own backbenchers came to my rescue...
...I told him straight out that I was appalled by yesterday's debate...
...He looked blank...
...Didn't you say that Sir Maurice's inquiry was going to come down against us...
...Bernard explained that at this hospital there are only 342 administrative staff...
...Look here," he began, "without those 200 people this hospital just wouldn't function ." "Do you think it's functioning now...
...The normal thing...
...The phone rang...
...he screamed...
...It would be an act of the most appalling financial irresponsibility to waste all that investment on . "But . . ." I said carefully, "what about the independent inquiry...
...Yes," I agreed...
...Edward's, to tell Sir Maurice we are making a brand-new hospital available to accommodate 1,000 refugees, and to tell the press it was my decision...
...How could you drop me in it like that...
...It seems there is a standard method of preventing this kind of thing leaking out...
...What else...
...So we reduced them ." Dimly I began to perceive what he was saying...
...I merely said there was no evidence of it ?' I think I was looking blank...
...I told her that this situation could not continue...
...These people, who are just passing through, cannot be permitted to interfere with the smooth running of government...
...Bernard and I turned on the television news...
...I was told rather sharply by a senior policy adviser that Number Ten had seen Billy Fraser on the six o'clock news...
...Well," he said, "it was completed eight months ago, and fully staffed, but unfortunately there were government cutbacks at that time and there was, consequently, no money left for the medical services...
...I repeated...
...to take some more Cuban refugees...
...Five hundred administrators...
...And they have told him that this is not unusual—in fact, there are several such hospitals dotted around the country...
...It was a real eye-opener...
...I was surprised...
...Oh," he said, "you're watching it ?' "Yes," I said through clenched teeth...
...Why didn't I know...
...He explained...
...He nodded again...
...I demanded...
...Rogers...
...Bloody hypocrite...
...Anyway," I concluded, "at least an inquiry gives us a little time...
...Bernard explained that apparently one or two people at the DHSS knew...
...The other 170 are porters, cleaners, laundry workers, gardners, cooks, and so forth...
...You want to put them out of work, do you, you bastard...
...Minister...
...Roy picked me up as usual, at about 8:30...
...Well...
...Edward's with medical staff...
...I studied his face...
...So am I, Minister," Humphrey said...
...Billy Fraser then started...
...One...
...Just no patients ." Could this be true...
...I added sarcastically...
...A totally unforeseen catastrophe...
...Oh yes," he answered cheerfully...
...We can't foresee everything ." Then his face resumed an expression of pure horror...
...What do they do...
...They finished building it 15 months ago—and it's still got no patients...
...Enough is enough...
...A thousand refugees with nowhere to go...
...To my intense surprise, he flatly disagreed with this proposition...
...You mean, 300 jobs lost...
...Ah," he said smugly, "if only British industry could match this growth record ." "Growth...
...Is that what you want...
...You asked me to find out about that alleged empty hospital in North London," began Bernard...
...Sir Humphrey shook his head...
...I asked him to drive me to the Ministry, as I was to spend all morning on Health Service administration...
...Into our departnient...
...March 16th This morning started none too well, either...
...I began to recover myself...
...I roared...
...She agreed...
...Make a few allowances for the differences between parliamentary and presidential government, and Yes, Minister tells you a great deal about how America is governed...
...I pointed out that that was how I had expressed it...
...Bernard asked me for a quote for the press release...
...How new...
...Sir Maurice it is...
...Edward's Hospital, aren't we, Bernard...
...He nodded...
...I told him to replace them with medical staff and open a couple of wards...
...How did you find out this good news...
...The average minister lasts only 11 months...
...You said reduce the figures, so we reduced the figures ?' "How did it get out...
...This, of course, was pure sophism...
...I asked cautiously...
...I had a lot of research done for me at Central House because I was unable to get clear statistics out of my own department...
...If you would be so kind...
...What if I'd been asked about this in the House...
...he said...
...March 22nd Today I had a showdown with Humphrey over Health Service Administration...
...If only you'd said we'd have a departmental inquiry," he complained, "then we could have made it last 18 months, and finally said that it revealed a certain number of anomalies which have now been rectified but that there was no evidence of any intention to mislead...
...If you say there was no intention, you can be proved wrong...
...assistant secretary is slightly more than 18 months...
...The following excerpt from Hacker's diaries comes from an earlier point in his training, when the minister is still tugging at his leash...
...Out with it...
...I inquired...
...But...you only reduced the figures, not the actual number of administrators...
...What outraged them was being told about it ." "Are we or aren't we agreed that there is no point in keeping a hospital running for the benefit of the staff...
...A most beautiful solution occurred to me...
...A small omission from the brief...
...Billy Fraser's razorsharp brain had finally got the point...
...He countered by offering to form an interdepartmental committee to examine the feasibility of monitoring a proposal for admitting patients at an earlier date...
...Gerry Chandler asked me if I could reassure my friends that the inquiries would not be carried out by my own department but by an independent investigator who would command the respect of the House...
...I gave in...
...I compromised...
...I was utterly delighted with that threat...
...I asked him how long that would take to report...
...the term expectancy of a U.S...
...It's up for the Florence Nightingale award ?' I asked what that was, pray...
...A hospital is not a source of employment, it is a place to heal the sick" He was livid...
...I mean, if you and Sir Humphrey Appleby went to work on a number 27 .. I interrupted him...
...Though I already know the answer— you might get caught rigging an independent inquiry...
...I inquired about the cost of it...
...Another leak...
...Not long, Minister...
...There was another silence...
...A thousand-bed hospital, fully staffed...
...Cynical as ever, he claimed that such an uproar proved his point...
...Humphrey accepts the job with his usual, "Yes, Minister...
...Or, as Hacker puts it, a certain warmth has developed in their relationship—as between a terrorist and his hostage...
...Hacker's diaries are supplemented by those of his aide, Sir Humphrey Appleby, the senior civil servant in the department (who has no doubt about who's in charge), and by the recollections of Bernard Woolley, Hacker's private...
...Who told you this...
...Bernard looked sheepish...
...Although I did manage to snatch a sort of Pyrrhic victory from the jaws of defeat...
...Sir Humphrey was pained...
...I couldn't believe my eyes or ears...
...All right," I snapped, "how would you express it...
...No," she said cheerfully...
...The money should be spent on patient care, surely...
...He refused point-blank...
...A sound man will understand what is required...
...Terrific...
...This seemed a perfectly reasonable figure...
...I paused to think...
...Edward's hospital," he said jovially...
...Then what about a retired politician...
...Hacker said that this was a tough decision but a necessary one, if we in Britain aim to be worthy of the name of . . .the compassionate society!' I asked Humphrey if he was agreeable to all this...
...Oh I see...
...On the contrary, Minister, it makes everyone better—better for having shown the extent of their care and compassion...
...Saying the trouble with the health and education and transport services is that all the top people in government go to private hospitals and send their kids to private schools...
...I agree," said Humphrey...
...I see your point, Minister," he replied thoughtfully...
...Yes, perhaps by then we may be able to open a couple of wards," he said...
...Leonard Reed, contributing editor March 15th I can hardly believe it...
...Department 10 contains administrators to administrate administrators...
...The first question was from Jim Lawford of Birmingham South-West who asked me about the government's pledge to reduce the number of administrators in the Health Service...
...No one was remotely concerned to find out what was being done with their money—it was their sacrifice, in fact...
...and unimpeachable integrity," added Humphrey...
...I asked...
...He's hoping for a peerage," said Humphrey quietly, with a smile...
...Ill-people...
...It is a sacrifice...
...One...
...Fine," I said happily...
...You don't think he might be too independent...
...But there are no patients," I reminded her...
...Why didn't you tell me...
...Perhaps in 18 months or so...
...Sir Maurice Williams could be the man," he went on...
...You should have stood up for the department—that is what you are here for...
...I said...
...In Sir Humphrey's parlance, "permanence is power...
...Yes...
...secretary...
...Humphrey then argued that if we closed the hospital now we would delay the opening of it with patients for years...
...With respect, Minister," began Humphrey, one of his favorite insults in his varied repertoire, "people merely care that the money is not seen to be misspent" I reminded him of the uproar over the mental hospital scandals...
...Rogers, beginning to sound impatient with me...
...Why...
...Are you suggesting that treating fewer and fewer patients so that we can employ more and more administrators is a proper use of the funds voted by Parliament and supplied by the taxpayer...
...Okay," I said, knowing that he had someone in mind already...
...Humphrey came in at that moment...
...Thank you," he replied, charmingly unaware...
...It's a source of employment for my members," he yelled...
...I laughed in his face...
...it is the civil servant, not the political appointee, who has tenure...
...Yes, well, Minister, in the course of time I'm sure...
...March 17th A long meeting with Bernard Woolley today...
...I'd had enough of this...
...But if " W eellll,, as I warned you, the drivers' network is not wholly reliable...
...He shrugged helplessly...
...Cuts down running costs...
...I never said there wasn't," Sir Humphrey replied impatiently...
...I asked...
...Quite impracticable," I explained firmly...
...He appeared to be serious...
...Parliamentary questions today were a disaster...
...They continually change the basis of comparative figures from year to year, thus making it impossible to check what kind of bureaucratic growth is going on...
...Yours...
...Everyone was shouting for an answer...
...When money is allocated to Health and Social Services, Parliament and the country feel cleansed...
...He repeated that if we lost our administrators the hospital would never open...
...I was slightly surprised to find him agreeing so vehemently...
...But Humphrey had come, apparently, on a different matter—of equal urgency...
...Absolved...
...I didn't particularly want an inquiry either," I pointed out...
...Clearly, he had no intention of answering any straight question unless it was expressed in terms he found wholly acceptable...
...He absolutely has to be sound" "If he's sound," I remarked, "surely there's a danger he'll bring it all out into the open...
...Growth...
...He will have a sensitive and sympathetic insight into the overall problem?' He was suggesting that we rig it, in fact...
...He appeared to think he was producing an ace from up his sleeve...
...The job of a professionally conducted internal inquiry is to unearth a great mass of no evidence...
...What's wrong with rigging an independent inquiry if you can rig an internal one, I should like to know...
...It was a noose...
...There is a huge Health Service waiting list...
...I also told him that it was my last word on the subject...
...No, Minister, in an independent inquiry everything depends on who the chairman is...
...Something like that...
...He was waving it about with a kind of wild glee, his fat face shining with excitement...
...Humphrey—or somebody—had been up to his old tricks again, disguising an increase in the numbers of administrative and secretarial staff simply by calling them by some other name...
...Why...
...So I told him just to sack the ancillary workers...
...I had to deal with the matter in hand, namely that I had agreed to an independent inquiry...
...At the end of the day," he began, "one of a hospital's prime functions is patient care...
...In real terms...
...But Sir Humphrey seemed pleased when I gave him these figures...
...The object—nay, the duty—of the civil servant is to "housetrain" the politicians or political appointees who have wandered into their midst...
...He started needling me right away...
...By "Number Ten" he meant the PM...
...I said...
...Humphrey," I said, very slowly and carefully...
...That's what Barbara Wodehouse says about her prize-winning spaniels," the advisor will add...
...What about an academic or a businessman...
...And I thought I detected a touch of admiration in his tone...
...You mean, rig it...
...Hacker can put out a press release announcing that, because of the successful conclusion of the economy drive, the staff is now being trimmed by 400 people...
...THE HOSPITAL WITHOUT PATIENTS A triumph of her majesty's civil service by Jonathan Lynn & Ant ony Jay Introduction by Leonard Reed 1 n 1985, WETA, Washington's public television station, imported another one of those BBC series...
...Sir Humphrey was puzzled again...
...But if you say the inquiry found no evidence of intention, you can't be proved wrong...
...Yes," I answered coolly, "I'd rather be compassionate to the patients than to your members" "We'll come out on strike," he yelled...
...First there was an item saying that the British government is again being pressured by the U.S...
...The Welcoming Committee—I use the term in the very broadest sense—was lined up on the steps...
...Purified...
...So I asked how many medical staff...
...Later, it played on 46 of the nation's 280 public TV stations...
...That-is-what-a-hospitalisfor...
...The stupidity of it ...the incompetence," I continued...
...Then we won't have to pay you ?' March 26th It seems I didn't quite wipe the floor after all...
...We are talking about St...
...I was appalled...
...I was forced to say I was happy to give that assurance...
...It was built for sick British, not healthy foreigners...
...It's brandnew, you see," he added as if that explained everything...
...He promptly handed me a list comprising all the administrative departments: Contingency Planning Department, Data and Research Department, Finance, Purchasing Department, Technical Department, Building Department, Maintenance, Catering, Personnel, Administration...
...Yours...
...You know, scaffolding and skips and things still there...
...But well, what can I do...
...Mine, Minister...
...Appleby's and Woolley's notes are important because, as Lynn and Jay observe, Hacker was once a journalist, and has no Particular talent for reporting facts...
...Well .. .yes...
...enquired Sir Humphrey coldly...
...It is one of the best-run hospitals in the country," she said...
...Well, as I warned you, the driver's network is not wholly reliable...
...There-are-no-patients...
...He's the driver for the Secretary of State for Health" When I got to the office I summoned Humphrey at once...
...Roy chuckled...
...This looked like it was going to be a real political stink...
...I was shown several empty wards, several administrative offices that were veritable hives of activity, and finally a huge deserted dusty operating theater suite...
...So 'sound' actually means `bent?' "I mean," he tried again, "a man of broad understanding!' I decided to short-circuit the process by making some suggestions...
...Is that what you call a compassionate society...
...It was called "Yes, Minister" and portrayed the relationship between the elected officials of Britain and its permanent civil service...
...The book that the show inspired consists of the fictional diaries of James Hacker, an aptly named member of parliament whose party has just won the elections and who finds himself a cabinet minister in charge (or so he thinks) of the Department of Administrative Affairs, which was created to control the civil service...
...I spelt it out to him...
...as head of the Department of Administrative Affairs, Hacker feels obliged to set a proper example and instructs Sir Humphrey to study how many people could be trimmed...
...I learned this morning that in ten years the number of Health Service administrators has gone up by 40,000 and the number of hospital beds has gone down by 60,000...
...Jonathan Lynn and Antony Jay 1981, 1982, 1983, 1984...
...He continued as if I had not said a word...
...I nodded...
...But to concede a full independent inquiry...
...You'd have to make the bus service much more efficient, wouldn't you...
...A new man is considered housetrained when he sees things through the eyes of the senior civil servants...
...Edward's Hospital...
...No, but the right finding will give him a few more Brownie points" "Right," I said decisively...
...10 Downing Street...
...The program was not wildly popular in Washington, possibly because both the bureaucracy and the politicians found it too true to be funny...
...On the pleasure-pain principle of behavior modification, Hacker finds himself paying increasing heed to Humphrey's guidance...
...Nowhere in my brief was there the slightest indication that you'd been juggling the figures so that I would be giving misleading replies to the House," I said...
...Minister," he admonished, "that is not how I would have expressed the question...
...Sir Humphrey was unmoved...
...He knows all right...
...Those abuses had been going on quite happily for decades," he said...
...This won't give him one, will it...
...I knew the answer before he gave it, "18 months," we said in unison...
...Eighteen months...
...Ah," I said...
...Yes," said Roy...
...Humphrey, you told me you were going to have a word with the unions!' "I did," he replied...
...You were lucky they didn't ask you about that new St...
...I can't think what came over you ." I blinked at him...
...I gave the prepared reply, which was a little selfcongratulatory— to the civil servants who wrote it, of course, not to me...
...I asked...
...Your stupidity, Humphrey...
...I was appalled...
...Humphrey was obviously expecting this question...
...We work long enough hours as it is, without spending an extra hour a day waiting at the bus stop...
...Don't you think there's something in it...
...He will perceive the implications...
...Published by Salem House...
...There the Prime Minister's political advisor will tell him the civil service is now saying he's a pleasure to deal with...
...Minister," he began, "that hospital has millions of pounds' worth of high-technology equipment...
...Furthermore the annual cost of the Health Service has gone up by one and a half billion pounds...
...This egalitarian stuff, though daft, is always a little dangerous if it's not watched very carefully...
...he smacked his lips...
...I wouldn't count on it," he snarled...
...To be fair, he personally hadn't dropped me in it...
...Very good thing in some ways...
...The day will come when an apprehensive Hacker will be called to No...
...So he persisted...
...Rogers informed me that, together with Radiotherapy and Intensive Care, it cost two and a quarter million pounds...
...I was rather pleased with that little crack...
...Rogers, the chief administrator, and an appalling Glaswegian called Billy Fraser who rejoices in the title of Chairman of the Joint Shop Stewards Negotiating Committee...
...I replied firmly...
...I pointed out that we simply haven't got the money to house any more refugees...
...Through the Private Secretaries' network...
...Good thinking, Humphrey...
...He nodded...
...I tried to explain to him that the money is only voted to make sick people better...
...Oh, none of them," replied Bernard casually, as if that were perfectly obvious in any case...
...How did you find out this good news...
...Certainly...
...Healing-the-sick...
...Roy has got it wrong ." I was very relieved...
...Edward's...
...If you create more work, more people have to be employed!' Humphrey then points out the advantages to his boss...
...But his precious department had...
...Apparently it has been contrived to keep it looking like a building-site, and so far no one has realized that the hospital is operational...
...How very nice to meet you," I said to Fraser, offering to shake his hand...
...A brand-new hospital," I repeated quietly, to make sure I had not misheard, "with 500 administrative staff and no patients...
...Humphrey saw what I was thinking, of course, and seemed all set to resist...
...It looks as if Sir Maurice Williams's independent inquiry is going to be unfavorable to us," he began...
...You talk," he said accusingly, "as if the staff have nothing to do, simply because there are no patients there...
...Why...
...It hardly seemed possible...
...Yes Minister," he said...
...My God," I said...
...It wasn't too popular out there either: nobody outside Washington believed that *overnment could possibly be run that zanily...
...Through the Private Secretaries' network . " you're drowning and somebody throws you a rope, you grab it ." "It was not a rope," replied Sir Humphrey...
...He said it was impossible...
...I didn't deign to reply...
...I suggest that we get rid of everyone currently employed at the hospital and use the money to open closed wards in other hospitals...
...Soon a story appears in the Daily Telegraph, noting with glee that Hacker has recruited 400 new civil servants in his "economy drive...
...Prolongs its life...
...My mate Charlie," he explained...
...Then he fell silent...
...Sack them all...
...What's more, an unsuccessful shabby deception—quite the worst kind...
...I was staggered...
...I asked...
...I instructed him to open some wards at once— and more than a couple...
...I wasn't too sure about this...
...But, until we have the money for the nursing and medical staff, that is a function that we are not able to pursue...
...Humphrey is astonished that Hacker is upset: "You demanded a complete survey...
...So does a time bomb," observed my permanent secretary...
...No, not if he's sound," he explained...
...Either she got patients into the hospital, or I closed it...
...How long...
...From The Complete Yes, Minister, by Jonathan Lynn and Antony Jay...
...This isn't a department, it's a colander...
...Somebody had leaked this wretched paper to Lawford...
...Please, do go on strike, the sooner the better...
...And they go to work in chauffeur-driven cars," added my chauffeur...
...I asked her if she was not horrified that the place was not in use...
...I told Bernard to reinstate, immediately, all the staff at St...
...Had it stayed secret, it would have been seen as a brilliant maneuver to pass off an increase of staff by 7 percent as a decrease of 11.3 percent— but when leaked, it suddenly comes into the category of a shabby deception...
...Although the Private Secretaries' network is sometimes a little slower than the drivers' network, it is a great deal more reliable—in fact almost 100 percent accurate...
...I asked him what we were supposed to do now...
...Patients...
...We pick up the story as Hacker is telling of his embarrassing performance that day before Parliament...
...I suppose," I said, "the Department of Health and Social Security (DHSS) haven't got enough money to staff it" "Oh, it's got staff," said Roy...
...I beg your pardon...
...But there was an intention to mislead," I pointed out...
...It's won," she told me proudly, "by the most hygienic hospital in the Region!' I told her that I'd said my last word and that 300 staff must go, doctors and nurses hired, and patients admitted...
...Roy has got it wrong . " I was very relieved...
...Tell them," I said, "that Mr...
...She started twittering...
...Minister," he said, "would you get rid of the Army just because there's no war...
...Couldn't we," I suggested thoughtfully, "get an independent inquiry to find no evidence...
...Humphrey, however, seemed disinclined to apologize...
...Minister," said Humphrey in his most injured tones, "you said you wanted the administration figures reduced, didn't you...
...I instructed him to sack half the administrators and half the ancillary workers...
...Nonetheless," she added, "the essential work of the hospital has to go on!' "I thought the patients were the essential work of the hospital" "Running an organization of 500 people is a big job, Minister," said Mrs...
...Mrs...
...I met Mrs...
...Yes...
...I agree, Minister," he said, "but nonetheless all of these vital tasks listed here must be carried on with or without patients...
...Chap just been talking about that on the radio," he said casually...
...And then— the bombshell!—Billy Fraser came on, and threatened that the whole of the NHS in London would be going on strike tonight at midnight if we laid off workers at St...
Vol. 19 • July 1987 • No. 6
