The capacity to form an orderly queue is sometimes held up as an admirable quality of the British character, perhaps from historical association with rationing and stoical patience in wartime. But the queue is also an emblem of failure. A famous political advert that helped propel Margaret Thatcher to power in 1979 depicted a line of people waiting to be seen by an unemployment office under the slogan “Labour isn’t working”. Now it is Conservative government that plainly isn’t working, and the queue is for public services. Many people were appalled, but perhaps not surprised, by scenes of queues that lasted three days this week as would-be patients tried to register at a new NHS dental surgery in Bristol.
On Wednesday, Victoria Atkins, the health secretary, announced an emergency funding package, offering dentists £50 for every new NHS patient taken on. The British Dental Association dismisses this as “rearranging the deckchairs”. Labour, which identified dentistry as an area of critical concern at the start of the year, promises a more substantial expansion of provision.
It isn’t just dentistry. Rishi Sunak admitted in a TV interview broadcast this week that he was failing to keep a promise to bring down waiting lists across the NHS. The prime minister disingenuously identified industrial action as the main obstacle to progress. The truth, as Mr Sunak knows but cannot express, is that waiting lists for planned treatments started growing in 2013, long before doctors went on strike and long before the Covid pandemic that ministers also routinely cite as the cause of all woes in the health service. Mr Sunak was not yet an MP when the seeds of the current crisis in public services were sown. But it is his party that is responsible, his government that is failing to get a grip, and his Conservative creed that prohibits a candid recognition of the underlying problem.
The UK state is crumbling through sustained underinvestment and a myopic political fixation on cutting spending without regard for long-term social consequences. Although notionally NHS spending was “ringfenced” in George Osborne’s austerity budgets, inflation of medical costs meant the same resources were stretched ever thinner. Meanwhile, the evisceration of non-ringfenced budgets increased the burden on frontline care. Local government was hit especially hard and lost much of its capacity for public health provision.
The advertised benefits of austerity – eliminating deficits and reducing reliance on public borrowing – did not materialise. The Tories were committed to reach a surplus on the state’s day-to-day budget by 2014-15. It didn’t happen until November 2017. Tory ministers cite unforeseeable extraneous factors for their fiscal failure. In the case of monetary finance to fund deficits through the pandemic, that is a reasonable defence.
But the underlying structural fault is refusal to conceive of public spending as investment that can yield economic efficiency by enabling a healthier, more productive society. The path of public spending needs to be explained. But Britain has engaged in masochistic austerity, driven by ideological aversion to activist government. Even now, when Britain’s public infrastructure is visibly derelict and people are queueing round the block to access services, Tory MPs deride public health interventions as the pernicious meddling of the “nanny state”. That is a complaint with scant resonance in places where the arm of the state is all too weak and the compassionate impulse of government conspicuously absent.
