Photo: Nick Moore/Alamy Stock Photo

State of denial: Can any British government afford to meet its citizens' demands?

All election talk was about a government that did big things. But are such ambitions economically credible?
June 21, 2017
Dismembered: How the Attack of the State Harms Us All by Polly Toynbee and David Walker (Gaurdian/Faber, £9.99)

Amid the many known unknowns of the election result, there are two overwhelming certainties. The first is that Whitehall faces—as Gus O’Donnell describes overleaf—a daunting couple of years, with Brexit dominating its workload. The second is that both the referendum and now the general election have revealed a yearning for a more active, engaged and effective state to alleviate social grievances and tackle the challenge of an ageing population.

Certainly, that is the message that Theresa May took from the heavy “Leave” votes across Britain’s depressed regions a year ago. She swore to use the muscle of government to lighten the load on the “just about managing,” and her manifesto stressed industrial activism and disavowed the Thatcherite belief in “untrammelled free markets.” It was a platform that won her 42.4 per cent of the UK-wide vote, exactly matching Thatcher’s landslide-winning score in 1983. May, however, came back to a hung parliament because of a stunning surge in support for Labour on the back of a manifesto which the Institute for Fiscal Studies believes would have got the state more  “deeply involved” in the private sector than it has been for a long time—“certainly since the 1970s, and perhaps since the 1940s.” Taken together, fully 82.4 per cent of voters backed May’s newly-interventionist Tories and Jeremy Corbyn’s more full-throated big government dirigisme. And that is the highest combined share of the two parties in many years. Britain, then, now wants a large and active state. The big and unanswered question, however, is whether it any longer has the capacity to be one.

That question—can the British state provide what is now asked of it—has not gone away simply because a weakened prime minister has found it convenient to proclaim to her unhappy backbenchers that austerity is over, without being at all clear what she means by that. It is a question that remains urgent. And it is the central theme of Dismembered: How the Attack on the State Harms Us All, a new book by Polly Toynbee and David Walker. The authors describe a public realm hobbled by the long slog of retrenchment, and deeply confused by constant re-organisation and the contracting-out of public services. It’s an angry book and one that captures an inconvenient truth: that British ministers of all persuasions are typically in a hurry to make a mark through shaking things up. Indeed, even back in the good years, when New Labour was ploughing in extra resources, its ministers thought that whatever they did had to create enough sound and fury for the public to notice they were doing something. If not, they worried that the public would never credit them with any improvement. More recently ministers have tinkered with one hand, while with the other they have swung the axe. Compulsive fiddling has become an easy alternative to facing up to what it would cost to give the public the services they expect.

A decade ago Christopher Pollitt, a specialist in public-service management, dubbed this process “redisorganisation,” a syndrome to which Britain was especially susceptible. Andrew Lansley’s shake-up of the health service in the early years of the coalition government was an egregious case in point. David Nicholson, the chief executive of the NHS at the time, quipped that the change was so big you could probably see it from space. But the costly disruption has been in vain: far from being transformed, hospitals have lurched into deficit. It is an all-too familiar tale in the NHS, and across the public services.
"A prime minister who really wanted to be radical would halt the incessant meddling and concentrate on making the existing structures work better"
Vocational education is another example of “redisorganisation.” A recent analysis by the Institute for Government (IfG) highlighted “the sheer scale of churn” in a further education system that has been repeatedly pulled apart and put together again over three decades. This sort of restructuring undermines the colleges and staff who are the last best hope of giving Brexit Britain’s workforce an urgent skills upgrade. “Students and employers are,” as the IfG puts it, “faced with a confusing and ever-changing set of qualifications.”

Redesigns that look clever on paper in Whitehall have ceased to help. A prime minister who really wanted to be radical would halt the incessant meddling and concentrate on making the existing structures work better. But May has already shown herself to be more of a tinkerer than a nurturer. This was made clear by her swift, post-referendum creation of two new Brexit departments. This was a mistake. The EU affects all aspects of government, and so it would have been more sensible to co-ordinate Brexit through the Cabinet Office—that is, to use the existing structures. Her misguided plan to shake up secondary education through academic selection may be toned down now that she has squandered her majority. But it could be another huge distraction that will do nothing to tackle the long-standing weakness of the worst schools. Whatever else May might do as she clings to power, it is hard to have much faith that it will draw a line under “redisorganisation.”

But it is above all the health of the public finances that will determine the fate of the British state in the years ahead. The essential questions are thorny. Has the state already shrunk too much through austerity, and should it be rebuilt? Is the state’s workload increasing in ways that mean it needs to be bigger than before, requiring higher borrowing and taxes? And, is there a way of getting it to work better, and of doing more with less? Haunting these questions is Britain’s withdrawal from the EU: will the Brexit economy deliver the taxes the state needs?

The immediate backdrop is the austerity of the Cameron/Osborne years. There were warnings from the very beginning, but—at the outset—the impact on services was muted. This was in part because the famine followed the prolonged public services feast of the Blair/Brown years. Wage freezes were initially easy to impose, because private sector pay had sunk so far in the slump that public sector staff were not going to be lured away. Polls suggested that the public remained pretty satisfied with state services. But if circumstances took the edge off austerity in its first phase, seven years on, far fewer of the mitigations apply—not even in those services that are meant tobe protected.

The NHS has been insulated by a “ring-fenced” budget and awarded modest spending rises, but it has still come under immense pressure. In a telling example, Toynbee and Walker show how podiatry specialists have been forced to economise on treatments for diabetes patients with foot ulcers that could prevent the risk of amputation. They also highlight staff cuts in environmental health, low profile but vital, which includes inspecting restaurants for food hygiene.

So how deep have the cuts been? One measure that captures this shrinking of the state is total public spending as a share of the economy. This has fallen from a peak of 45 per cent of GDP in 2009-10 following the financial crisis and great recession to 39 per cent in 2016-17. Put like that, it sounds like a very sharp drop. But in the immediate aftermath of the crisis, the state’s share of the shrunken economy was temporarily swollen. Another way of describing the current position is to say that the state is now back at its pre-crisis level in 2007-08, which doesn’t sound too austere. But this soothing characterisation of the position ignores the changing expectations and duties on the state in an ageing country. As recently as the late 1980s, Britain spent virtually the same on health and defence. Now it spends nearly four times as much on health. That re-balancing of commitments was eased by the “defence dividend” following the end of the Cold War in the 1990s, a free lunch no longer on offer.

From an international perspective the British state is stingier than most of its European counterparts, but more generous than the United States. Public expenditure in the euro area amounted to 48 per cent of GDP in 2016. French state spending is 56 per cent of GDP. By contrast US government spending was 35 per cent last year. Yet international comparisons only go so far, not least because of differences in the age composition of national populations, which mean differences in claims on the state—more old people means more pensions to pay.

Demography also colours interpretation of the cuts in the UK. The absolute level of total public spending has barely shifted in real terms over the past seven years. But because the population is growing, expenditure per person is down by 5 per cent. There has also been a sharp divide between the departmental budgets delivering public services that have borne the brunt of spending cuts and other more favoured forms of spending, particularly benefits for older people, which have risen sharply. By this March, real departmental spending per person was down by 15 per cent on 2009-10. And since some areas such as health have been shielded from cuts through ring-fencing, the cuts elsewhere have been even deeper, especially in policing and prisons. After the terrorist attacks in Manchester and London during the election campaign, the reduction in police numbers flared up as a political issue.
"The British state is stingier than most of its European counterparts, but more generous than America"
The strains of austerity are now palpable in many areas. Even in health, where real spending actually inched up—by an average 1.1 per cent a year under the coalition—the growth was tiny compared to the historical average of 4.1 per cent a year over the past six decades. It is probably because annual growth was exceptionally rapid—averaging 6.6 per cent—over the course of the New Labour noughties, that the immense pressures took so long to show up. But  the number of patients waiting more than four hours at A&E has now soared, while more cancer patients face unacceptable delays. Cameron was fortunate: things never got so bad in his first term. But within months of May taking over, the problems were impossible to miss. Unless a lot more money is injected into the health service—certainly more than the Conservative manifesto proposed—resource-strapped hospitals will not be able adequately to meet the growing demands for healthcare.

Some of the difficulties of the health service have arisen from cutbacks in social care, for which local authorities, whose own resources have been sharply reduced by the centre, are responsible. This has caused bed-blocking in hospitals as elderly patients are unable to find places in nursing homes or to arrange care in their own homes. The strains of austerity are also manifest in the disgrace of Britain’s overcrowded and increasingly violent prisons, with steep increases in assaults by prisoners on both fellow prisoners and staff.

Among other things, Labour’s strong performance at the election signals that the public has run out of patience with austerity. The cuts were initially bearable because they followed years of largesse—but no longer. The dilemmas are even sharper, because there are mounting expectations on the British state to do not less, but more in the future. Even more than other European countries, Brexit Britain, in its isolation, cannot afford to incur the wrath of Donald Trump for failing to comply with the Nato commitment to spend at least 2 per cent of GDP on defence. Tellingly, May faced down the tabloid press and committed to keep international aid at 0.7 per cent of GDP. As Britain forfeits the soft power that Europe wields, the judgment appears to be that rising spending in such areas will be required to ensure that we do not lose all our influence.

But ageing is the biggest expenditure challenge of all. After a brief immediate post-war spike in births, Britain’s real baby boom came between the mid-1950s and the start of the 1970s, with 1964 the peak year. Ever more boomers will thus be reaching their mid-60s over the next decade. Even though the state-pension age for both men and women will rise, to 66 by 2020 and then to 67 by 2028, expenditure on care and pensions will continue to climb. Health will also be affected, of course. According to longer-term projections from the independent Office for Budget Responsibility, the bill for pensions, social care and health will increase by 1.1 per cent of GDP in the first half of the 2020s, an extra cost which could—on its own—require five pence more on the basic-rate of income tax. Nor is there any relief at the other end of the age scale. Paradoxically, an ageing population also means more must be spent on the young. If the rising generation is relatively smaller, it becomes all the more important that they acquire more “human capital”—skills and expertise—if the economy is to carry on growing.

If the state is to become more capable in these circumstances, then it will come at a price. The necessary spending can be financed in two ways. One is to borrow more and the other is to raise taxes. On borrowing, whereas Cameron pledged in his 2015 manifesto to bring the overall budget into surplus by the end of this decade, May postponed balancing the books to the mid-2020s; in a chaotic hung parliament, even that will prove a stretch for her—or her successor.

Toynbee and Walker think the fuss about public debt is overstated and rests on a false comparison between households and government. But public net debt will peak this financial year at 89 per cent of GDP—the highest since the mid-1960s and up from 36 per cent a decade ago. According to the IMF, Britain’s net debt is the sixth highest among 26 advanced economies. Servicing it is manageable while interest rates remain so low, and yet the Treasury is right to worry about maintaining fiscal headroom to respond to a future downturn. That precludes—or should—being overly relaxed about today’s deficit. Besides, borrowing is plainly not a sustainable way to meet the demographic need for higher spending, which will apply for decades to come.

When it comes to raising tax, which Toynbee and Walker advocate, May has at least tried to keep her options more open than Cameron in 2015, by dumping his promises not to raise income tax and National Insurance. But she did nothing to prepare the electorate for tax rises, and in a hung parliament is likely to be too weak to get them through. The preferred strategy will be to dodge the tax question and gamble instead on another set of innovations and bright ideas to improve efficiency. Few would dissent from such a move, if it were feasible. In many ways it is what governments have been trying to do for three decades. Yet such reforms rarely live up to expectations.
"Even if the state can become a bit more effective, no likely breakthrough is going to get the government off the hook"
Previous innovations, like the Private Finance Initiative, certainly created work for accountants and city firms. In some specific circumstances, the injection of private capital may have sharpened up the incentives for providers. More often, however, the state found it tricky to write the contracts involved, and ended up paying over the odds. The overriding and barely disguised aim was to flatter the books, and some institutions, such as the former South London Healthcare Trust, ended up saddled with unmanageable debt. With the Tory manifesto pledging a major new programme of capital investment in the NHS even at a time when the overall capital budget will continue to be pretty squeezed, we could be in for wheezes of the PFI sort.

Employees tend to look askance at visionary new ideas handed down by management. What they want is decent pay, and to feel motivated. Rearranging the organisations they work in—through new types of school or hospital trusts—misses that crucial point, and is inherently wasteful and morale-sapping. The independent inspection of public services is a vital safeguard. But the unceasing attempt to monitor and control everything from the centre—a habit to which May appears temperamentally prone—undermines commitment and stifles initiative. Reform is needed in the civil service, which has to become far more proficient in using IT and in commissioning services. Julian McCrae of the Institute for Government hit the spot when he wrote last year: “For over half a century, Whitehall has conspicuously failed to develop the commercial, financial and project management skills necessary to run a modern state.” As well as acquiring such skills to act effectively when they must, officials must be wiser about when to refrain from interference.

Yet even if the British state can become somewhat more effective, no breakthrough is likely to get the new government off the hook. An ageing population will push up spending and require higher taxes. That makes it all the more important that the economy—the tax base—does well. Tackling Britain’s dire productivity is essential. There is a wide range of policies that could assist in improving efficiency, notably through raising research and development, modernising the transport infrastructure and improving skills. Encouragingly, these policies featured in the Conservative manifesto.

Yet governing is about priorities and the government’s other main task will be managing Brexit. If the negotiations go badly, and we end up with a “cliff-edge” departure from the EU, the impact on the economy would be grave. Even if the talks go well, the long-term effect of Brexit will be a smaller economy than previously expected, which feeds through to lower tax revenues. A sound economy is fundamental to the health of any state. As the tasks of government mount, it is doubly risky that Britain has gambled its economic destiny on an uncertain future outside the EU. If that bet goes wrong, all the political talk of a newly muscular state will be exposed as a cruel illusion.

Read more from this issue: No, prime minister: Britain will punch below its weight for as long as it has minority government