The public want a better state, not a smaller one

New Fabian Society research shows enduring support for government-funded public services.

This year’s US presidential election is a contest about the role of the state. Mitt Romney and his running-mate Paul Ryan offer American voters the choice of a radical small-state political economy, with less tax and much less public provision. Their prospectus is backed by a philosophy, championed by the Tea Party, which calls into question the very legitimacy of government action. Against them, Barack Obama offers a more European model of state-funded social entitlements. American politics may have plenty of faults, but shirking big debates is not among them.

A powerful strand in British political thinking has adopted a diluted version of US anti-state rhetoric. A combination of fiscal pressure and a reaction to New Labour’s centralist statecraft has led to a range of calls for a "smaller" state, which often conflate financial and organisational arguments. This is seen in the coalition government’s advocacy of "the big society" as something  ‘big state’. Even within Labour, parts of 2011’s The Purple Book argued in favour of "leaving the big state behind".

But the Fabian Society's new report No Right Turn challenges this presumption. The state is far more popular and less "problematic" than conventional political wisdom would have us believe. When it comes to arguments for or against state spending on public services, people are more concerned with competing notions of entitlement, compassion and desert, rather than debates about the size or scope of government. It is not the state in itself, but the values and ethos that state activity represents which matter.

People respond far more favourably to pro-state arguments than almost all of the arguments against strong state intervention. The most popular statement in favour of the state was one that saw public services as a system which we all put into and, at one point or another, get some return from. Egalitarian arguments stating that public services should be provided to all, regardless of ability to pay, also received strong support.

There are some conditions on the public’s support for the state. Conservative voters stand out from other voters, with all of our anti-state arguments enjoying a positive response from them. Labour, Liberal Democrat and, crucially, swing voters are all much less sympathetic to the idea of a smaller state or more private service provision. For these voters, including those who will decide the outcome of the next election, the values and ethos of the public good remain central to their expectations of public services.

A more difficult challenge is posed by continuing public concerns about welfare dependency. The only anti-state argument to enjoy a positive response across-the-board was that a strong state makes people more reliant. Labour has struggled to find ideas and language to respond to these concerns but if it does there is real prize. If the party can assuage fears about dependency then support for state action will become even more entrenched.

The Fabian research shows there is little appetite for a rapid roll-back of public services in Britain. The Ryan plan would receive short shrift from a public that is largely signed-up to public services based on values of the public good. If Labour can successfully answer the tough questions on welfare dependency, it can be confident that when it defends the state it will get a fair hearing from a public who want strong government-funded services.

The Fabian Society's new report No Right Turn: Britain’s enduring support for public services is published today.

Demonstrators protest against the government's Health and Social Care Bill in London, on January 31, 2011. Photograph: Getty Images.

Andrew Harrop is general secretary of the Fabian Society.

Photo: Getty
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Brexit could destroy our NHS – and it would be the government's own fault

Without EU citizens, the health service will be short of 20,000 nurses in a decade.

Aneurin Bevan once said: "Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community."

And so, in 1948, the National Health Service was established. But today, the service itself seems to be on life support and stumbling towards a final and fatal collapse.

It is no secret that for years the NHS has been neglected and underfunded by the government. But Brexit is doing the NHS no favours either.

In addition to the promise of £350m to our NHS every week, Brexit campaigners shamefully portrayed immigrants, in many ways, as as a burden. This is quite simply not the case, as statistics have shown how Britain has benefited quite significantly from mass EU migration. The NHS, again, profited from large swathes of European recruitment.

We are already suffering an overwhelming downturn in staffing applications from EU/EAA countries due to the uncertainty that Brexit is already causing. If the migration of nurses from EEA countries stopped completely, the Department of Health predicts the UK would have a shortage of 20,000 nurses by 2025/26. Some hospitals have significantly larger numbers of EU workers than others, such as Royal Brompton in London, where one in five workers is from the EU/EAA. How will this be accounted for? 

Britain’s solid pharmaceutical industry – which plays an integral part in the NHS and our everyday lives – is also at risk from Brexit.

London is the current home of the highly prized EU regulatory body, the European Medicine Agency, which was won by John Major in 1994 after the ratification of the Maastricht Treaty.

The EMA is tasked with ensuring that all medicines available on the EU market are safe, effective and of high quality. The UK’s relationship with the EMA is unquestionably vital to the functioning of the NHS.

As well as delivering 900 highly skilled jobs of its own, the EMA is associated with 1,299 QPPV’s (qualified person for pharmacovigilance). Various subcontractors, research organisations and drug companies have settled in London to be close to the regulatory process.

The government may not be able to prevent the removal of the EMA, but it is entirely in its power to retain EU medical staff. 

Yet Theresa May has failed to reassure EU citizens, with her offer to them falling short of continuation of rights. Is it any wonder that 47 per cent of highly skilled workers from the EU are considering leaving the UK in the next five years?

During the election, May failed to declare how she plans to increase the number of future homegrown nurses or how she will protect our current brilliant crop of European nurses – amounting to around 30,000 roles.

A compromise in the form of an EFTA arrangement would lessen the damage Brexit is going to cause to every single facet of our NHS. Yet the government's rhetoric going into the election was "no deal is better than a bad deal". 

Whatever is negotiated with the EU over the coming years, the NHS faces an uncertain and perilous future. The government needs to act now, before the larger inevitable disruptions of Brexit kick in, if it is to restore stability and efficiency to the health service.

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