The UK faces huge challenges on many fronts. For 2024, we are prioritising three in particular:

• Voters’ #1 concern – reversing the process of mass impoverishment, which has worsened in the recent cost-of-living crisis and means that over 4 million (roughly one in three) children in the UK are now living in poverty;
• Voters’ #2 concern – government policy is causing the NHS to fail;
• An even bigger concern – UK democracy is under threat.

Voters’ #1 concern – reversing the process of mass impoverishment

From the 1920s until the Global Financial Crisis, the norm in the UK – as in most other countries – was progress. Most years, most people got slightly better-off. On an annual basis, that did not make much difference, but over a generation, it was transformative.

Since 2010, the median earner has seen an unprecedented fall in living standards. The norm has become regress. Most years, most people have got very slightly worse-off. With regress, as with progress, on an annual basis, that did not make much difference, but even over a half a generation, it has been transformative.

As we pointed out at the time of the last Budget, government policy will perpetuate and even exacerbate this downward trend – but this is completely unnecessary. A key focus of our work this year will be to raise awareness of these issues with the public, with the media, and even more importantly with policy-makers.

Voters’ #2 concern – government policy is causing the NHS to fail

The NHS was until the early 2010s ranked as the best healthcare system in the world.

Since then, due to sustained underfunding and increasing privatisation of services better provided publicly, the NHS is struggling badly.

The government constantly refuses to admit both the underfunding and privatisation, but as the Westminster Hall debate on The Future of the NHS showed, their denials do not hold water.

Recent developments add further concern – the Public Accounts Committee has concluded that £ billions in so-called NHS expenditure was not in fact procured by the NHS under its normal competitive rules but by others under special emergency legislation. This includes £ billions on PPE, much of which was unusable and which is still under investigation and on the so-called NHS Test and Trace system of which the NAO said,

“NHST&T has an unusual organisational relationship with the Department, with unclear accountability. NHST&T is subject to the Department’s financial, information and staffing controls, but its head, the executive chair, does not report to the Department’s ministers or permanent secretary, but rather to the Prime Minister and the Cabinet Secretary.”

And there are new procurement regulations from 1 January this year to enforce further privatisation (using the euphemism ‘patient choice’) which include the following instructions to the Integrated Care Boards (ICBs) which decide what health services are to be provided by whom:

“Please note, an ICB [Integrated Care Board] cannot refuse to provide an accreditation process for patient choice pathways based upon the rationale of protecting sustainability of NHS services. NHS Trusts are expected to compete with ISPs to maintain market share.”

In other words, even if an ICB can see that further privatisation would destroy NHS services, it cannot refuse to privatise. What has happened to NHS Dentistry is about to happen to other NHS services. Already we are in a situation where people are again pulling out their own teeth; if we are not careful, that failure of provision will apply to other areas of our health.

We are working hard to raise awareness, particularly among policy-makers, who can take action on these issues. We produced a seminal report The Rational Policy-maker’s Guide to the NHS and launched it in Westminster, where it is currently the subject of an Early Day Motion. We are also taking the report to the Scottish Parliament in Edinburgh and the Senedd in Cardiff.

UK democracy is under threat

These policy issues are vital to the health and wealth of the UK population. But even more important is the issue of democracy. As Churchill said, “Democracy is the worst form of Government except for all those other forms that have been tried from time to time.” Democracy does not prevent us from electing bad governments which implement bad policies – that is true – but it does give us the vital right to sack them if they do so.

That is why we should take very seriously the warnings from the Electoral Commission about the fairness of future UK elections.

As we wrote last week,

“We remain uncomfortably close to re-electing a government which has already shown a track-record of systematic removal of democratic safeguards.

In the UK, the polls suggest that this far-right version of the Conservative Party will lose the next election. But should they find a way to win, despite their weak overall track record and lack of popularity, it would be debatable whether Britain remains a functioning democracy. If they somehow retain power, and continue with their dismantling of our democratic safeguards, Britain might soon look more like Hungary under Orban than Denmark under Frederiksen. The consequences for British citizens would be dire – and long-lasting.”

We have set out in Chapter 15 of the book 99%, and more briefly in this article, five key steps the UK needs to take to address the challenges above, the first of which is a Democratic Reset – defensive constitutional reform to ensure that bad actors will find it far harder in future to subvert democracy.

Conclusion

In the UK, we are already poorer than we should be – indeed many Britons are now poorer than their counterparts in Slovenia, and far behind their counterparts in North Western Europe. Our public services are failing – even the NHS is not performing as it should, and the health and even life expectancy of British people has reversed its long upwards trend, especially among the most deprived. We are one of few developed countries where life expectancy is falling.

This failure of our healthcare system is now in turn affecting the economy, as our NHS report warned and others have since confirmed. Andy Haldane, former Chief Economist at the Bank of England and head of the government’s so-called levelling-up task force, admitted to  the Times Health Commission: “For perhaps the first time since the industrial revolution, health factors are acting as a serious headwind to UK economic growth. They are contributing significantly to a shrinking labour force and stalling productivity.”

Of course, we need to change track – or a vicious circle of a weak economy damaging services and health will cause an unhealthy workforce which further weakens the economy. And in a democracy, we can change track – as long as we can change the government. So as we argued last week, the next election is the most important of our lifetimes.

For The 99% Organisation then, these are our clear priorities. If you share these priorities, please:

• Make sure you will be allowed to vote at the next election – that means registering and making sure you have valid voter ID;
• Use your vote tactically – even if that means holding your nose and voting for a party you do not really admire;
• Do whatever you can to raise awareness of these issues – for example by sharing this article using the buttons below.

If you think you might like to help us address these issues by getting involved personally, take a look at The 99% Organisation and join us.

And if you are a politician from any party who would like to see the UK return to sanity, please reach out.