The next Labour government will not be able to use spending to blunt sharp choices in the public sector. The deficit is one reason, and a very big one: by 2015, Labour would have the option of doubling the education budget, were that money not already necessary to pay the interest on our public sector debts. But the deficit is not the only reason: new money that can be found will likely be quickly drained in an ageing society where the average cost to the NHS of each of the growing number of retired households is nearly double that of non-retired households. Given the spending reductions taking place right now, little more will be got from reducing waste and inefficiency in 2015: in many places we may inherit services pared back to the bone.
When money is tighter, suddenly that demand for more school sport is now a demand for less spending on science equipment; funding for lung cancer is not funding for breast cancer; more time pursuing violent crime means less time pursuing property crime, and so on.
There will be some areas where it is appropriate to be conservative: to say that the current service is quite good and any proposed model of giving away power is quite risky. But when we are outraged by the failures of the current system, then we are pushed into a more radical position. We know that we will now only rarely have the option of trying to be radical by spending more. That leaves structural change as the only radical course.
There are also occasions when we might consider making a distinction between what people want, and what they actually need. So no one will ever campaign for a hospital ward to close, but there may be times when it makes more medical sense to have a central group of specialist surgeons performing a complex operation more regularly, rather than having someone in each local hospital perform that surgery once a year. The problem is that if you spend your time in opposition suggesting that everyone’s wants will be acceded to, you have very little to stand on if you later try to make a distinction between wants and needs. The political question is: given a finite number of conflicts a re-electable government can enter into, where do we care enough to say no to the wants of sections of the public, management or staff?
Occasional crises – as can happen whenever you try and give power away – and regular protests can throw a government off course, make it reactive and ineffective. The best inoculation against such an eventuality is to decide, as a party, what risks we are ready to take and what fights we are willing to have.
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Steve Van Riel is a political consultant at Centreground and was Labour’s director of policy at the 2010 UK general election. His Purple Paper, public services and political choices, can be downloaded here