'Culture' as a camouflage of reality

'Culture' has now become the buzzword to explain the failings of an intractable social and economic reality, says Jeremy Seabrook.

---

WHEN I was a child - before a National Health Service was established in Britain - the great 18th century bulk of the Infirmary shadowed the streets where we lived. The people would pass by hurriedly, believing that these were places where people went to die; once inside, you would be lucky to see the light of day again. When my grandmother fell and broke her hip, she lay in bed for 13 weeks before succumbing: this only confirmed what everybody thought they knew about hospitals.

The National Health Service (NHS) was to have done away with such prejudice. The welfare state, benign, compassionate and kindly, would transform the way we thought about health and sickness. The fear of being ill because of the cost would be lifted from the people. No more would women hide the growth beneath their pinafore, struggling on until they could scarcely walk, nor men cough until their lungs had wasted away beyond help.

Hospitals were transformed. Light and airy wards, the latest technology, miracle drugs and the best of treatment for all would lift the stigma of hospitals as holding-stations for the dying. The old superstitions would be swept away. The wonders of modern medicine replaced the fatalism that when your time had come there was nothing to be done about it.

The recent scandal at the Mid Staffordshire Health Trust in the West Midlands, described in detail in his report by Robert Francis QC, tells a story that makes one wonder whether those people who saw hospitals as antechambers of death were not perhaps, after all, right. Hundreds of patients died needlessly between 2005 and 2009. The report is a catalogue of neglect and denial by staff obsessed with targets and the managerial 'throughput' of patients rather than with the care and comfort of individuals. It was only thanks to the tenacity of a group of people whose loved ones had died needlessly, often from causes unrelated to their original condition, that the inquiry was held at all. The concerns of grieving relatives were originally brushed aside, denied or ascribed to a desire to 'make trouble'. The corporate culture was the culprit.

The report made 290 recommendations, including regulation of 800,000 health care assistants who do much of the basic care of patients, a legal 'duty of candour' compelling staff to own up to errors and managers to face disqualification if they fail to 'deliver' good care, and a prohibition on personnel concealing medical and procedural errors.

It is, however, the general conclusions which ought to give pause for thought. Francis declared, 'Individuals and indeed organisations acting in accordance with a culture, even a negative or unhealthy one, cannot always be held personally responsible.' Much is made of the 'culture' of the NHS, which focussed on systems and ideology rather than the needs of patients.

Cultural determinants are to blame, and the eminent QC is at pains to exculpate those individuals who bore the values of that 'culture'. Despite the excessive number of deaths, no one can be found to accept responsibility: the culpable can bathe in the healing waters of an impersonal culture.

Defective 'cultures'

In the week when the 'culture' of hospitals came under attack, the culture of banking was also - yet again - in the spotlight. The Royal Bank of Scotland was fined œ390 million for its role in rigging the inter-bank lending rate, the so-called Libor rate. There was a culture of manipulation; safeguards, watchdogs, audits, systems and controls were all faulty. Some brokers believed the rules did not apply to them. A culture of impunity has been discovered in banks which, because of their critical importance in sustaining the economy, must not be allowed to collapse.

This does not exhaust the list of defective 'cultures' in Britain which came to light recently. Michael Gove, the Education Minister, forced to abandon some of his 'reforms' of the education system, nevertheless insists that he will continue to tackle 'the culture of competitive dumbing down', and demands 'a decisive shift in the culture', away from 'small-c conservatism'.

Why is there suddenly so much talk about 'cultures'? How come that the apologists of the status quo have become anthropologists, Malinowskis of the shires, Talcott Parsonses of suburbia? How can Conservatives talk so glibly about changing cultures, as though this could be accomplished by the flick of a switch? What term of convenience is this, and what is this benign euphemism designed to conceal?

It is now acknowledged almost without challenge that Western society has reached such a state of perfection that it requires no alteration; is this not the template for a whole world anxious to emulate our achievements? Equally true is it that the economy is also unchangeable: in spite of the failure of banks, the tenets of balanced books and deregulated finance now have the allure of scriptural revelation, and fairy-stories for adults are now widely circulated about geese that lay golden eggs, magic wands and financial wizardry. Since these great monuments to universal civilisation are no longer susceptible to improvement, the concept of 'culture' has been introduced as a painless (and one suspects, quite ineffective) alternative. It can be flourished like a banner at all the recalcitrants and deniers of progress, since cultures are now discovered to be as mutable as the British climate.

This is why we hear of a 'culture of bullying' in schools, a 'culture of disrespect', a 'culture of violence', a 'culture of neglect', a 'culture of alcohol-fuelled crime'. Cultures, malleable, as readily put on or set aside as a garment, have become the arena in which change is possible.

Easy response

Culture, then, is camouflage, the easy can-do response to intractable social and economic reality. As far as the Health Service is concerned, the policies of the Coalition government - with its insistence on savings, cuts and organisation changes - will lead to an even more business-driven model, which was at the root of the callous myopia of personnel under the same baleful imperative. Privatisation of health care by stealth is the objective beneath all the prescriptions for shifts in institutional culture, and the demand that we change 'the way we do business'. Stress on the aberrant culture of banking has, of course, a quite different aim - the maintenance of the existing order, mending the system and preserving the primacy of London in the global financial services sector, since money is the principal item of manufacture in this former workshop of the world.  The educational cultural change is in the interests of reverting to a more rigidly hierarchical structure, where the vocation of power is distinguished from the lesser callings of the multitude.

One lesson from the distant and discredited 1940s might be useful. My relatives, who distrusted the Infirmary, retained a justifiable diffidence in their response to all official efforts to improve, correct or chasten them. Such scepticism is required more than ever now, in a dispensation from which both society and the economy have absconded, and where we are left with nothing but the anthropological cult of cultures in and out of which we can slip at will.                               

Jeremy Seabrook is a freelance journalist based in the UK.

*Third World Resurgence No. 269/270, Jan/Feb 2013, pp 60-61