Books: Dismembered: How the Attack on the State Harms Us All

For 40 years or so, beginning with the rise of Thatcherism, the state has been in retreat in the UK, and especially in England. Private enterprise has been courted, praised and rewarded by governments both Conservative and Labour. Nationalised industries have been sold off to private bidders, many of them foreign; the NHS has been subject to endless reorganisations and reforms, all of them based on unevidenced pursuit of marketisation; schools have been torn from local government and ‘academised’; civil servants and bureaucrats have been ridiculed and scorned; planning departments, health and safety and environmental health offices, the police and even the armed forces have been cut and cut again; local government has been tasked with delivering more services while its budgets have been slashed; and tax of all kinds has been characterised as a regrettable imposition. All this has been presented to the country as though it was self-evident that ‘private’ must be preferable to ‘public’, and that ‘the market’ must be more efficient than any form of state enterprise.

The authors of this book both work for the Guardian, which is its joint publisher, and their approach is unashamedly polemical. They set out in exhaustive and sometimes exhausting detail the scale of the assault on the state, and they show how the language of right-wing ideology has come to prevail in the media and in public discourse. Their plea is for a restoration of trust in and respect for public service; for policies to be based on evidence rather than ideological assumptions; for public squalor to be addressed in preference to private affluence; for the proportion of GDP to be spent on public services to be increased from the current 39% back towards the 45–50% that most Western democracies aim for, rather than towards the 36% that is the target of the Conservative government. Their argument is backed by a series of journalistic reports from the frontline, based on interviews with often quietly heroic public servants doing their best.

A sticker on my copy reads, ‘Read this before you vote’, but by now the voting is over. The extraordinary reversal in the fortunes of the two main parties at the election suggests that the pendulum might at last be swinging back in the direction that the authors desire. A wide readership of this book might give it a little extra impetus.

• © British Journal of General Practice 2017