The talented young doctor, part of the brilliant cancer team that has been treating my wife for the last 22 months, is resigning and going to the US. His decision is partly informed by the opportunity to do well-funded frontier research and partly by his conviction that the government is hellbent on dismantling the NHS and has zero interest in the wellbeing and careers of those who work in it.
To toil in the present-day NHS is thankless. There have always been trade-offs in health provision; resources are not limitless and priorities have to be set. The health secretary, Jeremy Hunt, is in a quandary. He rightly wants a 24/7 NHS and too much weekend provision on current terms is substandard. Yet boxed in by too tight spending limits, he can only achieve his objective by not offering a premium for junior doctors working on Saturdays. Whatever its merits, a workforce whose morale is already low sees it as yet more evidence that professionals’ views don’t count. Morale takes a further downward lurch.
The entire public sector is blighted by the same malaise. The government has volunteered to make debt reduction a greater public purpose than the ends for which the public sector is designed. Health and education provision or policing and environmental protection? All must be secondary to the greater goal of ensuring that by 2019 the stock of public debt is falling as a share of GDP, even though the cost of servicing our stock of national debt has been higher for most of the past 300 years.
Thus by 2020, the government will have imposed an unprecedented 10-year freeze in real pay across the public sector, shrunk its numbers by more than 1.5 million and offered as little upward career progression to public employees as it possibly can. A new industry of private contractors feeding off contracted-out public work will have been invented, offering even worse pay and conditions than the public sector itself. To raise taxes that might alleviate the crisis is ideologically prohibited.
Employees are voting with their feet. Between November 2013 and November 2014, 49,120 teachers quit – the highest rate on record. Nearly four in 10 newly qualified teachers leave after their first year. Two-thirds of secondary school heads or deputy heads are considering early retirement. What should be one of the noblest professions of all has been turned into the country’s poor relation, endlessly criticised, indifferently paid and in the front line of stewarding and caring for children as much as teaching them. To have a stable pool of teachers offering continuity, especially in subjects such as maths, is becoming a rarity. The new norm is a high turnover of teachers with pupils taught by a succession of supply teachers.
Last week, Bernard Hogan-Howe, Metropolitan police commissioner, warned that next month’s comprehensive spending review would mean the Met having to lose another 5,000 to 8,000 officers even as London’s population expanded. Few who know the Met would regard it as a paragon of efficiency and enlightened attitudes towards women and ethnic minorities. Yet at the same time, it pioneers some of the smartest policing in the world, with some of the most sophisticated terrorist and criminal detective work around. Rather than pulverising cuts to its manpower, pay and conditions to achieve an arbitrary budget target, it needs repurposing and re-professionalising – the best parts nurtured and the worst parts eliminated. In the current climate, even to make such an argument is to bay for the moon.
It has become impossible to think straight about the state. The only permissible discourse is to talk of shrinking, fragmenting and privatising it – opening it up to competition and market forces. It is accepted as axiomatic that a public institution will be bureaucratic, self-serving and its employees wildly overpaid, unionised and lazy. It is this culture that allows the government to aim to eliminate the budget deficit almost entirely with cuts in departmental spending.
Who cares about the state? If it becomes very much smaller with a demoralised, indifferently paid and de-professionalised workforce, so what? Yet economies and societies need functioning states. There are spheres of activity in our lives animated by a distinct ethic of public service. I want my doctor to get me well, not to over-prioritise a budget target or quota. Teaching is about an ongoing relationship of trust between teacher and pupil. Taxes should be collected and justice administered upon principles of impartiality and fairness. Police exist to provide order and justice for all. The infrastructure essential to modern life is publicly provided.
Once this was common ground across British politics, encompassing liberal Conservatives as much as the Labour party. There was a co-dependence between public and private to create a dynamic mixed economy and thus a need for a fit-for-purpose, functioning state. There are proper arguments about degree, but the fundamental conclusions were agreed. There need to be health, education, police and tax collection professionals and dedicated civil servants who are offered reasonably well-paid careers to deliver in the public interest.
Now to challenge the paraphernalia of contracting-out, privatisation, de-professionalisation, public sector pay freezes and the rest is to be stigmatised as a socialist. Indeed, one of the tragedies of modern British politics, created by the cowardice of so much New Labour thinking, is that it is only the Bennite socialists now in control of the Labour party who make the argument for the state. This then proves to the mainstream that once commonplace assumptions are really fearfully left wing.
So far the hollowed-out public sector has been resilient and the momentum of the decent provision of the Labour years, uncelebrated by those who authored it, has disguised the mounting shortfalls. Tax revenues are more buoyant than expected. The Treasury may be able to achieve its targets without some of the more outlandish proposed cuts. But the numbers of doctors, teachers and other public servants now quitting amid such a collapse in morale are a storm warning that should be heeded.
The vast bulk of the electorate want and expect decent public services, threatened by current spending levels, let alone new cuts. The prime minister and chancellor should beware. They and their party will not escape the consequences if public services deteriorate any more and will find themselves as aghast as the New Labour establishment at the improbable beneficiary – Mr Corbyn.