Strong and resilient public services are vital for a strong and robust economy. Public spending supports employment, drives economic growth and ensures we have a healthy and skilled workforce.

Since 2010, our public services have been deliberately under-resourced and under-staffed by successive Conservative governments. International spending comparisons show that UK spending on health is 18 per cent less than the European average and would need to rise by £40bn a year to match per capita health spending.9

Austerity approaches to public spending harm our economy, stalling productivity and growth, as we have witnessed throughout the last 12 years – see sections 4 and 6. They also harm our overall health and wellbeing. The crisis in social care and its consequences are the clearest example of this.

The levels of unmet care needs in the UK were unacceptably high before the pandemic, and were exacerbated during the crisis. Acute staffing challenges in social care meant that 1.5 million hours of commissioned home care could not be provided between August and October 2021 because of a lack of staff.10  The number of people awaiting assessment for care in England increased in 2021/22 – as of September 2021 an estimated 70,000 people were awaiting assessment, which quadrupled to 294,000 people as of April 2022.11

The lack of care, or delays in initial assessments for appropriate care, are putting people at significant risk. Without the care or support people need, health conditions are likely to deteriorate, and individuals may grow more vulnerable. Hospitals are unable to discharge patients that are medically fit because they don’t have the right care in place to return home. This puts pressure on hospital beds, causing blockages in A&E departments, resulting in ambulances spending hours on hospital forecourts with patients. Yet again, putting lives at risk. NHS England figures, obtained by GMB union through a freedom of information request, show deaths in ambulances have doubled in the last year and incidents where the patient suffered severe harm while in ambulance transit have tripled.12

Underinvestment has also resulted in declining outcomes for children and higher costs for the taxpayer. Effective early intervention in family life reduces the need for more expensive state intervention in later life. In 2021 the House of Lords Public Services Committee reported that between 2010/11 and 2019/20, local government spending on early intervention fell by 48 per cent to £1.8bn while spending on costlier, higher-intensity interventions like youth justice increased by 34 per cent to £7.6bn.13

As this example shows, our public services are a deeply interconnected ecosystem, underfunding in one area put strains on other areas too. Backlogs, delays and soaring unmet need have a material effect on people living in the UK and on our economy. As a nation, we are getting sicker, with average life expectancy falling in 2020 for the first time in 40 years.14  Workforce participation has fallen sharply, with over 500,000 working-age adults ‘missing’ from the workplace since the pandemic. Meanwhile, the number of working-age adults identifying as economically inactive due to long-term sickness rose by the same number - half a million to 2.5 million, up from 2 million over the same time period.15

Strong public services are the backbone of a strong and stable economy. Delivering that, requires effective and well-resourced public services, staffed by a valued and motivated workforce. Yet, key areas of the public sector are facing severe staffing shortages, following more than a decade of government-imposed real terms pay cuts for the workforce.  

Nurses have lost £42,000 in real earnings since 2008 – the equivalent of £3,000 a year. For midwives and paramedics, the losses are more than £56,000 – the equivalent of £4,000 a year.16  In the education sector, teachers and school leaders have lost around a quarter of their pay since 2010 according to separate analysis by the NEU 17 , NASUWT 10  and NAHT.

New research published by the TUC found that around one million children with key worker parents are living below the poverty line, representing 19 per cent of children in key worker households.18"

The toxic mix of pay cuts, unsustainable workloads and low morale are forcing workers to leave in droves in search of better paid jobs. A TUC survey found one in three public sector workers have taken steps to quit or are actively considering doing so, with the majority citing pay as the main factor 19

Vacancy rates in health and social care have reached record highs at 10.5 per cent 20  and 10.7 per cent respectively. This is a worsening situation – 2021/22 saw the highest recorded annual vacancy rate in social care - 165,000 vacant posts, up 52 per cent from the previous year. 21  In education, retention rates have reached a historic low - just two-thirds of early-career teachers (67 per cent) remain in the profession after five years. 22  In local government, employers have warned a third of councils in England do not have the skilled staff needed to deliver key services. 23

While we have high vacancy rates and real terms pay cuts for public sector workers, we cannot get to grips with the issues facing our country. Staff shortages put huge strain on those who remain as they try to plug the gaps, fuelling excessive workloads and long working hours. This undermines the quality of our public services, and leads to high rates of attrition and absenteeism. These vacancies are hard to fill, due to the skilled nature of the work. High turnover costs the public purse, in the loss of knowledge drawn from years of hard work and experience, but also in the increasing reliance on agency staff as well as recruitment, induction and training costs.

There is also a strong economic case for investing in public sector pay, as we set out in the following section.

• 9 The Health Foundation (2022) How does UK health spending compare across Europe over the past decade
• 10 a b ADASS (2021) ADASS November 2021 Snap Survey Report. https://www.adass.org.uk/ snap-survey-nov21-rapidly-deteriorating-social-services
• 11 Association of Directors of Adult Social Services, Waiting for Care and Support, 13 May 2022, p. 5, www.adass.org.uk/media/9215/adass-survey-waiting-for-care-support-may-2022-final.pdf; Association of Directors of Adult Social Services, ‘ADASS Survey – adult social care: people waiting for assessments, care or reviews’, 4 August 2022, p. 3, www.adass.org.uk/media/9377/adass-survey-asc-people-waiting-for-assessments-care-or-reviews-publication.pdf.
• 12 GMB (2022) https://www.gmb.org.uk/news/ambulance-admission-and-transfer-deaths-more-double
• 13 House of Lords public services committee, ‘ Role of public services in supporting vulnerable children’, November 2021, p4
• 14 ONS (2021) National life tables – life expectancy in the UK - Office for National Statistics (ons.gov.uk)
• 15 ONS (2022) Half a million more people are out of the labour force because of long-term sickness - Office for National Statistics (ons.gov.uk)
• 16 TUC (2023) Patients overwhelmingly back striking NHS key workers – new TUC poll | TUC
• 17 NEU (2022) (neu.org.uk)
• 18" TUC (2022), 1 in 5 key worker households have children living in poverty (tuc.org.uk) 
• 19 TUC (2022) https://www.tuc.org.uk/news/around-1-3-key-workers-public-sector-have-taken-steps-leave-their-profession-or-are-actively
• 20 NHS Digital (2022) NHS Vacancy Statistics (and previous NHS Vacancies Survey) - NHS Digital
• 21 Skills for Care (2022) https://www.skillsforcare.org.uk/Adult-Social-Care-Workforce-Data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx
• 22 House of commons library (2022) Teacher recruitment and retention in England (parliament.uk)
• 23 LGA (2023) 2022 Local Government Workforce Survey | Local Government Association