Time we decided how national wealth should really be measured

ONE in nine people are currently waiting for treatment on the NHS - that's something like 7.5 million people nationwide.

Patients driven to desperation by waiting times have reportedly reached the point of trying to crowdfund private treatment.

BBC investigations show others are resorting to loans in order to avoid the logjam facing our health service.

With ambulance trusts nationwide having declared black alerts - meaning even heart attack sufferers could wait hours for paramedics - and concerns over an "alarming collapse" in the quality of GP services, it's hard to overstate pressures.

Don't take my word for it - Rishi Sunak - the man who until weeks ago was in charge of the nation's purse strings has now said emergency action is needed.

Ministers will almost certainly point to the pandemic as having poleaxed services and of course the greatest public health crisis of modern times cannot have failed to have had an impact.

One may question of course whether the much-touted "living with Covid" strategy -  better understood as pretending a still unpredictable pathogen peaking every three months has gone away - could do with some refining.

Yet in truth our NHS was in an increasingly dire state long before the novel infection arrived.

Weeks before the worrying new illness emerged in Wuhan, the British Medical Association (BMA) warned the health service was facing its worst ever winter - with hundreds of thousands to be stranded on trolleys for more than four hours.

Indeed as cabinet minister Nadine Dorries helpfully admitted in her haste to hole the leadership prospects of former Health Secretary Jeremy Hunt, it was woefully under-equipped to deal with the coronavirus crisis.

The UK has far fewer acute beds compared to the likes of Germany, numbers of clinicians have plummeted and a dire shortage of PPE stocks proved deadly in the pandemic's first wave.

The increasingly grim condition of one of our most cherished institutions is just one symptom of the wider sickness gripping our most critical support networks.

What we might call "the public services crisis" has been worsening for years.

Unlike the "cost of living crisis" currently grabbing headline the effects have often been incremental and may go unnoticed since most of us, fortunately, aren't relying on all of the arms of the state all of the time.

While the soaring cost of a grocery or gas bill is there to be seen in black and white for anyone who has to go to Tesco or has central heating, plummeting standards in services are often more insidious.

It's quite possible that you won't know quite how bad it's got in hospital wards or classrooms or care homes unless you happen to have been in one recently.

Although the fact that not all of us need every service is cold comfort for patients desperately waiting for cancer screening, families trapped on housing lists or victims of household burglaries - for whom a police visit is by no means assured.

It is perhaps no surprise that Tory leadership hopefuls have engaged in a race to the bottom on taxes and say almost nothing about exhausted A&E departments or cash-strapped councils struggling to cover even statutory services - those most essential functions required by law.

Sunak somewhat broke ranks this weekend when he outlined the dire state of the health service.

The intervention followed several weeks of candidates trying to corral votes with ever more ludicrous promises to boost business, while ignoring the dysfunction we face as a country.

Failed contender Nadhim Zahawi was at least perhaps honest when he suggested the cost of his proposals to hack taxes would mean a 20 per cent hit for Whitehall budgets. Although he was probably less candid about what quite this would mean for services already squeezed by years of austerity.

Thatcher tribute act and now favourite to win Liz Truss would no doubt argue her own plans to dramatically reduce Corporation Tax will encourage the investment which will allow us to flourish as a country.

But our rates are already the lowest in the G7 and have done little to offset the squeeze on public spending or the decline in services which follows.

Even if this strategy were to pay for itself - and the Office for Budget Responsibility (OBR) has ruled it will not - how many more years of decline can we endure before we reach the sunny uplands?

Conservatives often talk of their love of Britain but do they love seeing its green and pleasant parks strewn with litter?

They laud law and order but can you reconcile this with police services reduced to rapid response and magistrates courts mothballed? If justice is seen to be done in 2022 it is in many cases many miles from the town where the crime was committed.

And of course they always wax lyrical about the free market  - of creating the conditions for businesses to thrive - and yet there are now more food banks in Britain than there are branches of McDonald's.

So for those MPs falling over themselves to endorse the "shrink the state, slash the taxes" plan, they should perhaps be asked quite how they square the strategy with their protests when services disappear from their own patch.

When a backbencher is willing to pose - arms folded, frown fixed - in front of an under-threat swimming pool or a road riddled with potholes, it suggests a fundamental dishonesty about quite how we got here.

Tories need to be clear that the fiscal policies they bray for from the green benches have very real consequences on street corners in their constituency.

In the very worst cases reduced resources make terrible tragedies harder to prevent; failures by social services to prevent the fatal abuse of Arthur Labinjo-Hughes and Star Hobson are only the latest to end up in the spotlight.

These most horrendous cases are only of course at the worst end of the spectrum of what happens when services end up forced to impose cuts year-on-year.

More common is the increasing tendency of residents to notice that their community is getting less cared for or that there are fewer facilities than there used to be.

Arthur's local authority of Solihull has on its own lost an ambulance station, tourist office, travel shop, several day centres and a magistrates court in a little over a decade.

Of three police stations serving the patch 10 years ago, one has closed altogether, another has lost its front desk and the third is set to downsize.

The hospital has had its maternity wards massively scaled-back, the Casualty closed altogether and more recently a Minor Injuries Unit withdrawn due to the Covid backlog.

The truth is that even more affluent areas, which may have been sheltered from the earlier rounds of austerity, have since felt the effects of a crumbling public realm.

Only the very richest, after all, can afford private school fees or the homes on gated estates which negate the need for decent numbers of police officers or adequately-equipped classrooms.

At this stage, a braver Labour Party would already be sharpening the knives. But can a typically timid Keir Starmer follow the example of his predecessor, whose promise of much-needed investment dramatically changed the debate during the 2017 election.

The shock loss of their majority forced re calibration in Conservative ranks. Indeed much of Johnson's mandate rested on now infamous pledges for 40 new hospitals and putting bobbies back on the beat.

While these promises seldom survived contact with fact-checking services, it shows that his administration at least recognised public discontent was such that explicitly asking them to absorb further cuts was increasingly difficult.

Now though the demands for a larger, more muscular state look set to be ignored by both Johnson's eventual successor but perhaps more troublingly their political opponents.

Campaigning for the leadership two years ago Starmer insisted Corbyn had been right to be radical, but there will be fears that an increasingly conservative opposition may instead seize on the chance to prove its financial discipline.

While a speech earlier this month did promise to reinvigorate public services, it also described them - rather worryingly - as Labour's "comfort zone".

It's true that they're an area where voters have traditionally trusted the party more than the Tories and Starmer could argue the opposition must now build confidence in those areas such as balancing the books.

The problem here is that if Labour quickly commits itself to stricter constraints on spending or rules out certain wealth taxes - the party's past pledge to tax top earners and big businesses looks increasingly shaky - where then does it go?

This is not 1997 when a strong economy and stabler backdrop allowed Gordon Brown's Treasury to reap the benefits and reinvest. We live in an increasingly insecure world, with globalisation being thrown into reverse and war and climate change overshadowing us all.

Now is not the time for concessions to George Osborne's old dogma about deficits, which most Tories themselves now barely speak about.

If progressive politics is to succeed it cannot afford to race to where it believes the public opinion is but must make the case for why it believe things can be better and how to make this possible. 

Since most people - I firmly believe - ultimately want to live in a country where people and places are properly looked after, this can be an argument that should eventually even overcome the relentless onslaught of press attacks and establishment fury.

If on the other hand our leaders cannot bring themselves to say that improved services need investment they must instead be honest about the alternative. 

It means a bit more money to go out at night, but streets which feel ever less safe to do so. Plenty of talk about a country of opportunity but where even basic services are increasingly disintegrating. Is this the sort of nation we want to be?