The Eichmanns who rule our lives

Whether we are doctors or single parents, we are all victims of petty bureaucrats

The sclerosis of the British public service is evident to any observant person who works in it or has any contact with it. Part of this sclerosis derives from the piles of official rubbish that emerge daily from Whitehall, but a good part also arises locally, from the rules and procedures that small bureaucracies impose upon themselves. The effect of these rules (and I suspect their purpose, too) is to generate work without ever achieving its ostensible purpose: a form of employment insurance. Everyone is busy, but no one does anything.

For example, as a hospital doctor, I find it increasingly difficult to speak to my consultant colleagues by telephone. It is not that they are unwilling to speak to me - on the contrary. Rather, the people whose job it is to answer the telephone have become ever more obstructive. Whereas not many years ago I would get straight through to them, more or less, it now sometimes takes several days before I can speak to them, and hours of frustrating effort as well as lost temper.

I have come to dread having to speak to them, though communication between doctors is a first principle of good medical practice.

A few days ago, I wanted to refer a patient to Dr T. I phoned his office and explained what I wanted to a function- ary there.

"Our system is that you have to write him a letter," I was told.

"Yes," I said, "I do that as a matter of routine. But I also want to speak to him."

"There's no need. Once you've sent the letter, the case will be picked up."

"I want to speak to him none the less," I said.

"That's not our system. Our system is . . ." I slammed the phone down.

The following day, after sending a letter of referral by fax, I phoned again and asked to speak to Dr T.

"You need to send a letter of referral," I was told.

"I've done that."

"Then the case will be picked up automatically. There's no need . . ."

"Look," I said, "I'm a consultant, and I demand to speak to Dr T. This is not a request, it's an order."

Something in my voice suggested to him that he had better do as I said, and within ten seconds I was speaking to Dr T, who was most helpful and accommodating. But I had had to expend some of the declining capital of consultant authority to get through to him, and had wasted nervous energy in doing so. I spend several hours a month in this fashion.

The rule that I could not speak to him was entirely arbitrary and unnecessary. I give my patients my direct telephone number (excluding those who I think are likely to abuse it, who are not many) in order to save them and others the bureaucratic hurdles they might otherwise have to jump in order to speak to me. In the past 12 years, I haven't received more than a very few unnecessary calls, and I have saved many people hours of fruitless labour and frustration.

But complications generate work: and every bureaucrat fears redundancy, however relentlessly he has seen his office grow over the years.

Arbitrary rules cause great suffering, however, to those whose lives they affect. Recently, I had a patient who took an overdose because her landlord - the housing department - had been hounding her for back rent for more than a year. A single mother of three by a father who would rather give up work than contribute a single penny to his offspring's upkeep, she wanted a transfer from where she was living to a less violent area: she lived in a tower block, and it was unsafe to let her children out to play because of the gun-toting drug dealers who pullulated in the area. She wanted to move nearer her mother, so that her mother could look after the children while she went to work. It sounded like a good plan in the circumstances.

But she couldn't be considered for a transfer, she was told, because of the back rent that she owed. However, there was no question that this money was not in fact owed - that the housing department had made a mistake. She was on income support and therefore also in receipt of housing benefit at the time the alleged debt accrued.

The housing department asked her for proof that she had been on income support all this time, which she duly provided; but the department then said that it was too late. Once a debt had been owed for so long, there was nothing that could be done to abrogate it, even if it had not been rightfully contracted in the first place. It was then that she took to the pills.

My letter to the director of housing produced an immediate response: the alleged debt was cancelled. The anxiety of the patient, the Herculean efforts of the housing department to recover the "debt", were completely unnecessary and pointless. Not that the department was apologetic - far from it. When next my patient went to the office to renew her application for a transfer, she was told that she was extremely lucky to have had her debt cancelled after so long a period. Normally, the department would continue its efforts to "recover" the money.

These are not isolated incidents, but increasingly typical ones. I deal with them every day.

They seem to indicate on the part of bureaucrats a complete lack of normal human feeling, not to mention incompetence, stupidity, cruelty and a delight in the exercise of petty arbitrary power all rolled into one. They indicate that many (though not all) people in the public service have lost sight entirely of the ostensible ends of their work.

In their own very small way, they are Adolf Eichmanns.

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