What will you cut next, Mr Osborne?

The Tories' plans mean that tax giveaways can only be funded by even deeper cuts somewhere else. Labour should take a different path.

George Osborne’s speech did little to answer the question that is at the heart of the Tories’ plans for the next election: what will be cut next? The conference has opened with news of mortgage guarantees, tax giveaways and the introduction of a new 'Help to Work' programme, but this week’s announcements will be dwarfed in scale by the spending plans the government has already published earlier in the year, which promise a further £24bn of cuts in 2016 and 2017.

The Fabian Society’s commission on future spending choices has examined the impact these plans might have. We found that if all the cuts were levied on day-to-day public service spending, department budgets would fall by 8 per cent over two years. In principle these cuts could be spread thinly between public services, but continued protection for the NHS and schools is more likely. If all the areas George Osborne protected in this summer’s spending round were safeguarded again, on average, other public services would see their budgets fall by a quarter. Coming after so many cuts during this parliament, areas like local government, the criminal justice system and further education would face collapse.

At last year’s Conservative conference, George Osborne set out his alternative: a further £10bn of social security cuts. So far, in the face of Lib Dem resistance, he’s found only one third of that total - by restricting increases to many benefits to 1 per cent a year. Presumably a Conservative manifesto will promise further restrictions to social security and our commission looked at where £10bn of benefit cuts might come from. The news is not good for politicians looking to win elections: we concluded that savings on this scale would only be possible by reducing pensioner entitlements or means-testing all the remaining universal entitlements for working-age households.

Attacking the popular parts of social security would be highly controversial of course, but it would only slightly ease the pressures on public services. Even after £10bn of new social security cuts, many departments could still face budget cuts of 15 per cent over the two years from April 2016. So when Conservative politicians offer more of anything over the next 18 months, voters should beware. On their current spending plans, a new promise can only mean even deeper cuts somewhere else.

There is an alternative, according to the Fabian commission. With the economy finally growing again, big post-election reductions to social security and public service spending are a choice, not a necessity. Whichever party is in power, there will need to be financial discipline and tough choices, but there is also more room for manoeuvre than George Osborne seems to think. This is because today’s unexpectedly strong economic growth will translate into higher than predicted tax revenues. The Conservatives are earmarking this money for pre-election tax cuts, but it can instead be used to stop cuts. There is also the option of raising taxes for high income groups who are set to be the first to feel the benefits of recovery. Together these two measures would more or less avoid the need for cuts after 2015.

This week the Conservatives are confirming they would prefer a different route. Devoting the 'proceeds of growth' to pre-election tax cuts may seem like good politics, but it will create avoidable devastation to public services and further reduce public spending in areas critical for future economic success.

So far Labour has been silent on its post-2015 spending choices; it was the missing link for the party’s conference relaunch. But in due course Labour must set out spending plans which are fiscally water-tight but also entail spending more than the Conservative’s plan for cuts.

This is the, so far unspoken, dividing-line which will come to shape the next election. Labour should start to shout about it, because Conservative tax cuts will come with huge costs.

George Osborne arrives to deliver his speech to the Conservative conference in Manchester. Photograph: Getty Images.

Andrew Harrop is general secretary of the Fabian Society.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear