Jumbo or Dwarf? The Size of the State

... From podiums and interviews come echoes of Margaret Thatcher's cry to "roll back the frontiers of the state". First we had Grant Shapps saying the state should "get out of the way" and Nadhim Zahawi talking of slashing departmental budgets by 20 per cent; now we have Penny Mordaunt calling for "low tax ... small state" principles and Liz Truss declaring that she has a "plan to bring down the size of the state" ... Perhaps this is music to the ears of Tory members, but I find the whole thing perplexing and dispiriting. 

Elephant in the Room
Chierol Lai (b. 1995) and Hannah Stewart (b.1976)
Photo Credit: Queen Mary, The University of London [CC BY-NC]

Perplexing because this state-shrinking talk seems curiously adrift from what is happening in Britain in 2022. Are the candidates aware that ambulance crews are taking an average of 51 minutes to reach heart attack and stroke victims? Have they tried to get an appointment with a GP? Have they received constituents' letters about grindingly long delays with getting passports, driving licenses, probate applications, tax rebates? What of the huge numbers on NHS waiting lists, the cancer surgery backlog, the young people waiting three years for mental health care, the autistic children waiting five (yes, five)  years for a first appointment? What of the fact that police are solving their lowest proportion of crime ever? Let's not even start on housing...

But really, how can anyone serious look at the pile up of problems here and conclude that the imperative is not to make the state better but to shrink it?..

Surely this a time to be ensuring that the state is strong, resilient and well resourced for the next crisis not for plotting how to find tax cuts so more middle-class people can afford Nespresso machines and Land Rover Discoveries on £600-a-month finance deals...

For a long time the British Social Attitudes Survey has sought views on tax and spending. Since 1983 the camp wanting to reduce taxes and spend less on health, education and social benefits has bumped along the bottom of the graph, below 10 per cent. For the past 40 years the vast majority have either wanted taxes and spending to stay the same or rise...

We need optimism about the good that government can do and urgency about how best to reform ailing parts of the public sector, not an ideological obsession with shrinking the state at real cost to millions of people.

'Baicco', The Roman Dwarf 
Philip Wickstead (D. 1790)
Photo Credit: Burton Constable Hall [CC BY-NC-ND]

(Clare Foges, The Times, 2022)

How about increased levels of taxation on the richer elements in our society so that public services can be improved? For example, Germany attracts far higher levels of investment than the UK but has corporation tax rates at 30 per cent. In the UK the main rate is 19%. Denmark has a personal tax rate of 55.9 % on its richest citizens and still manages to have an average monthly income which is 1,449 euros, greater than that of the UK. (3,900 to 2,451).

Nine European countries -  Denmark, France, Germany, Austria, Sweden, Finland, Iceland, Ireland and Luxembourg - have higher 'top personal rates of tax' and their monthly average wages are higher than those in the UK. (Figures from the Tax Foundation) 

Sir, How refreshing to read Clare Foges on the need for a new Conservative vision for our public services - a subject that has largely been missing from the leadership debate. As she notes, Britain's public services are in crisis after more than a decade of under-investment. Tax cuts would only deplete them further. We need greater efficiency, yes, but it was truly depressing to hear four candidates promote cheap, populist tax reductions and the fifth prioritise short-term debt reduction.

(Huw Marks, Kingston, Surrey, The Times, 2022)

Sir, Clare Foges is absolutely correct to debunk the smaller-state plans of the leadership candidates. She reports on the increased proportion of the population that is elderly. The welfare state has been very successful but a long period of Tory government has failed to grow it properly. An honest debate is required as to how the country should cope with a rising demand for welfare provision.

(Wynn Griffiths, Thornton-le-Moor, N Yorks. The Times, 2022)

*... A devastating report from the Commons health and social care select committee reveals "the greatest workforce crisis" in its history, with long waiting lists caused by a shortage of 105,000 doctors, nurses, midwives and others.

... Now France has 11% more doctors per capita and Germany 48% more, and virtually all EU countries have more beds.

... But the fastest way to grow capacity is by releasing NHS beds blocked for lack of social care.

...  I joined Citizens UK demonstrating last week outside the big care companies, all reaping fatter profits than pre-pandemic, yet paying staff below the real living wage. One by one, care workers told of their hardship on pitiful pay, even though "you clapped for us". And yet the Tory leadership frontrunner Truss would give away £30bn in tax cuts to better-off people. That money would go a long way in NHS and social care pay.

(Polly Toynbee, The Guardian, 2022)

*The BMJ argues "At no other time in the past 50 years have so many parts of the NHS been so close to ceasing to function effectively." The crisis in ambulance response times, queues in casualty and waits to see a GP are obvious examples. This is down to a long-term failure in workforce and capacity planning and repeated failures to sort out social care, as well as a denial that the pandemic is still here... It was clinging on by its fingertips before the pandemic, after a decade of austerity and 100,000 frontline staff vacancies. Rishi Sunak's bold promise of "tough targets" is unenforceable without a healthy, well resourced workforce.

(Private Eye, No 1578)

*Sir, ... We have fewer doctors per head of population than all other western European countries, and the majority of OECD countries, and our number of GPs per capita has fallen 10 per cent since 2015... This is exacerbated by a loss of infrastructure: the UK has one of the lowest numbers of hospital beds per capita (2.45 per 1,000 population) in Europe, about a third of the level of Germany. We also have one of the lowest numbers of intensive care beds in Europe at 6.6 per 100,000 population. The OECD states that just before the pandemic the UK spent 3,154 [Euros] (£2,640 in 2019) per person per year on healthcare, lower than most of western Europe.

With these limited resources, the NHS must in effect ration access to its services, which it does by waiting lists: if you can live with it, you must wait.

Until voters push their politicians for the healthcare system they want, little will change.

(Jonathan Sturgeon, MBBS, MRCPCH, Research fellow, Queen Mary, University of London,

The Times, 2022)

*Sir, ... Consider the positions of the 12 other countries in northwestern Europe. Every one of them has a higher income per head than the UK and their average for last year was 27 per cent above our income per head. As important, every one of those nations is less unequal than we are, with an average Gini index of income distribution after tax of 28.5 per cent, compared with our index at 36.6 per cent. This means that the poorer half of their people have incomes 40 per cent above their UK counterparts.

The question to be asked is why we cannot do as well as they do on both average income and equality, which would enable us all to cope with the energy and cost of living crisis. It is not that they are exploiting lower taxation, as their latest reported average tax take is 17 per cent above that of the UK. Careful, sober realism might be effective if we were prepared to do a proper study of what these countries are doing and maybe learn from them - but perhaps that would be deemed unpatriotic.

(Peter Howard, Haslemere, Surrey, The Times, 2022)