Hospitals, courts, councils and many other institutions on which the public relies have reached what feels like a permanent state of crisis. This is the stark message of a new report from the Institute for Government, and one that is addressed both to the current administration and whoever wins the next general election. Difficult as things are now, after 2025 the outlook is even worse, given current spending commitments.
These will lead to cuts in the budgets of most departments apart from health and defence. It is a worry that Labour has told voters it would mirror Tory fiscal rules on spending if elected. Eight of the nine services covered in the study are performing worse now than they were in 2019-20. The good news, says the institute, is that the pandemic is no longer directly affecting public services. The bad news is that the state’s ability to bounce back from Covid has been severely hampered by historical capital underinvestment, as seen in Britain’s crumbling schools, defunct NHS computers and inadequate prisons.
Only in schools does the research offer a crumb of comfort. Most are financially secure at the moment, although the widening attainment gap, declining attendance and a lack of trainee teachers mean there is cause for concern here too. Hospitals and courts are singled out as the two most problematic areas. The colossal waiting list for medical treatment, which stands at 7.75 million in England and is predicted to reach 8 million (with nearly 2 million more waiting for treatment across Northern Ireland, Scotland and Wales), combined with workforce issues including strikes, means that the health service overall is severely compromised. In a comparable situation, courts are faced with a huge backlog of almost 90,000 cases.
In primary care the situation is less acute, partly as a result of the increased responsibilities handed to pharmacists. But GP shortages are still a problem, as is the vacancy rate of almost 10% in adult social care. Across the public sector, the rate at which experienced staff are leaving is ringing alarm bells. Along with pay and working conditions – particularly the demanding shift patterns of 24-hour, seven-day services – the report refers to the “dissipating goodwill” of workers who feel unappreciated. It also criticises the government’s intransigence with regard to industrial action. Ministers, the authors point out, cannot legislate their way out of a workforce crisis.
An assessment of local services including libraries and support for rough sleepers has been added since this research was last carried out. Unsurprisingly, given the intense pressure council budgets are under, these also show a marked decline. As in central government, the knock-on effect of certain categories of spending being protected is that other areas suffer all the more. Currently, the combination of rising social care and housing costs is driving numerous councils towards bankruptcy.
Just as there is variation across the different services, the situation in different parts of the UK is not the same. In Scotland the justice system, health and schools are devolved, meaning ministers there are responsible for prisons and courts, though room to diverge from UK government policy is constrained by the Treasury’s control of most taxation and borrowing.
If the solutions proposed by the thinktank could be summed up in one word, it would be planning. Short-termism has become a dreadful habit, encouraged by the endless round of musical chairs around the cabinet table. If the UK wants public services that are fit for the 21st century it will have to invest in them, and crucially in the people who work in them. With the damage of the past 13 years everywhere to be seen, Labour should pluck up its courage and say so.
