public health

We’re all in agreement that everything in Britain is broken. The whole national health service is on the verge of collapse, from cancelled GP appointments to ambulances and A&E departments so overwhelmed that it is approaching a humanitarian crisis. Travelling anywhere by train is either catastrophically expensive, unreliable, overcrowded, or some combination of the above. All this was the case even before a winter of strikes. Our infrastructure is creaky or crumbling. Housing is unaffordable. Heating is unaffordable. Everything is unaffordable and nothing seems to work as it should do. It isn’t hard to search for causes. After a decade of austerity, the public sector was running on fumes even before the rolling crises of Covid, energy price hikes, and the double problem of inflation and rising interest rates. When interest rates were low and investment would have been cheap, we were cutting spending instead. As Jonn Elledge phrased it recently, the government "had the perfect opportunity to fix the roof while the sun was shining". Now it’s too late. Growth is stagnant, and borrowing expensive. Brexit has shrunk the economy, slowing down trade with barriers and red tape, and taken investment elsewhere. Institutional mismanagement has been compounded by a lack of institutional continuity, amid years in which politics seemed to be characterised by round after round of prime ministerial and cabinet musical chairs. What hasn’t been mismanaged has been defunded. This is a crisis, too, of morale. Workers – including, but not restricted to – nurses, doctors and hospital staff, bus drivers, railway workers, teachers, university staff, civil servants, driving examiners, airport workers and the postal service, feel overworked, underpaid and undervalued. Inflation has offset any meagre gains that have been clawed back since 2008 – workers now are being paid less in real terms than they were 14 years ago. We are living through the largest fall in living standards since records began in the 1950s. Taxes are high, and it’s not clear what we’re getting out of it. This is both an emotional and an economic problem. The strikes by NHS and rail workers have revealed just how dependent we are upon goodwill: upon workers’ willingness to keep putting in overtime, to stay on after hours, to go above and beyond until these extra efforts become systematically expected of them. We are beginning to find out what happens when the goodwill is gone. Most of us are bad tempered, stressed, desperately anxious about the future and in survival mode in the present. Anxious about getting ill, and whether we or our loved ones will be able to access appropriate care. Anxious about not being able to afford basic necessities. Our national conversations are filled with voices telling us to tighten our belts (belt-tightening that has been prescribed, year on year, for a decade and a half), to cut down spending on little luxuries, to cancel Netflix subscriptions and gym memberships – increasingly, to forego all non-essential pleasure before complaining about economic insecurity. This isn’t living, it’s enduring; and living, we are told, is a privilege for those who can afford it. When things are going this wrong, it’s hard to keep track of which aspirations are realistic. The economic damage has been done, and clearly we can’t afford to fix all our infrastructure and public services simultaneously, as well as giving everyone all the pay rises they would have had in another similarly wealthy country, at the same time as building enough houses for them. But we know we can afford more, and better. We see the alleged beneficiaries of wasted PPE contracts owning yachts and multimillion-pound houses; we read news stories reporting on how they have offshored the rest of their astronomical profits. We can see that the profit margins of Britain’s largest companies are 73 per cent higher in 2021 than 2019, and that firms are taking advantage of the inflation crisis to ramp up prices far in excess of what is necessary. We can see that executive pay is soaring. Stocks are running low of the most expensive bottles of vintage champagne, as luxury goods company – who fine-tune supply and demand flows years ahead – fail to keep up with the scale and pace of wealth transfer to the very rich. We are being gaslit. [See also: Ministers are “sabotaging” efforts to reach pay settlements, says new TUC head]

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