TAX cuts or tax rises? That’s the question, say arch Guardian Labourites Polly Toynbee and David Walker, because it’s time to start talking about what sort of society we really want to live in.

The Tory manifesto of tax cuts had led to a public sector that was sick at heart – “it’s dwindling away and the very fabric of our public life shrinking with it”.

In their latest book, Dismembered: How the attack on the state harms us all , they investigate to what extent – and how far we would be prepared to go to defend it.

The effects were felt at grassroots level, whether we realised it or not, they told an audience in the Queen’s Hall on Saturday.

“You have all come to a festival,” Polly began. “I imagine most of you will have had a meal out or bought a sandwich and when you do that you assume the kitchens will have been checked by Environmental Health, but this is no longer the case.

“We have spent time with environmental health officers and they have been cut by a third.”

There were fewerinspections, less often, as a result and the lowering of hygiene standards would surely be the outcome.

David said: “Who supplies water to the Tyne Valley? The Cheung Kong (Infrastructure Holdings) company has taken over supplying the water here (it acquired Northumbrian Water in 2011), but how does the public interest of the Tyne Valley compare with the other services the overarching company supplies around the world? Who can say?”

Northumberland County Council had a PFI contract with French-owned SITA to clear waste, so those who had voted to leave Europe in the hope of taking back control would not be taking back control of their own bins from a management board that was two-thirds French nationals.

“This book provides a sense of how and why the public realm has become so fractured,” he said.

From border controls to that subject without borders, climate change, and public transport to the building of public infrastructure in general, there was only one entity capable of assuming the reins.

“It’s about trying to confront the issues that affect our country in the 21st century, and our argument is only the Government, or the state, is capable of tackling them,” said David.

“The CBI said to the Government it must set the nation’s standards of productivity, which indicates to me the Government needs to step in because targets are needed.

“As we get older, we do tend to have greater needs, in terms of both social and physical welfare, and the only entity that can organise that is the Government.

“Climate change affects us all and it’s not something the market has shown it’s capable of dealing with, so it will have to be a collective response.

“And getting young people equipped with the skills and technology they will need in the 21st century can’t be achieved by any other entity than the Government.”

The question about what kind of country people wanted to live in was all the more pertinent when we are heading for an election, while at the same time being on a trajectory to reduce public spending to 35 per cent of GDP.

Germany spent 44 per cent, France about 50 per cent and Scandinavia was traditionally higher than that. We are being reduced to the same sort of level as America, which was hardly the epitome of bureaucratic efficiency – its health care system, despite being reliant on private insurance, was among the most inefficient in the world.

Polly said: “Do we agree with Margaret Thatcher, who said you will always spend the pound in your pocket much better than the state will?

“But what can you achieve with that pound yourself? We’re thinking about your children’s education and your parents’ care and your own health.

“What about the public having a transport system to be proud of, which you often see on the continent but not here?

“I think we value what is bought with the pound that goes to the state more than anything you can buy in the shops.”

Chairing the event, Jonathan Morrell, from BBC Newcastle, commented that the duo had considered services, particularly in the NHS, that others would probably have overlooked. Podiatry was one such example.

Polly, who has been keeping a close eye on the health service ever since her years as the BBC’s social services editor, said the transformation in recent times had been huge.

“Services such as podiatry are incredibly important in keeping elderly people able to walk, keeping them robust.

“Health visitors, in the 15 minutes they are allotted, aren’t going to pick up on such problems and in these terrifying times of diabetes, an ulcer on the foot needs to be tackled quickly. One hundred and thirty-five people a week are having a foot amputated because they didn’t have a podiatrist look at it quickly enough, which is a horrifying figure.

“Podiatry seems to be an optional extra in some people’s views, but a small amount of spending now can save a lot of money and human suffering in the long run.”

The couple had spent time with Bedfordshire Police, who, like police forces nationwide, were under a lot of pressure, not least because of a 20 per cent cut in budget.

The calls they had listened to being taken in the control room were often less to do with crime and more to do with social breakdown – someone with a mental health problem who had gone missing, someone who was suicidal, a plethora of domestic disputes reported by worried neighbours, and so on.

“It was people ringing in distress and they expected the police to deal with it,” said Polly. “When the mental health nurses have gone home, it’s the police who are expected to respond.

“They are not just a crime service anymore, they are a social service too, and the more that other services fail – and mental health services are failing badly – it’s the police who are there to sweep up.”

Fifty per cent of NHS money was spent on the two per cent of the electorate who needed a lot of help – the very frail elderly, the vulnerable young and people with mental health problems – and young people, mainly those who hadn’t yet started their own families, often begrudged paying taxes.

They didn’t appreciate what was needed by society until they or their families needed it.

David said: “The visibility of these services isn’t necessarily great and people say ‘what’s the state done for me?’

“But we are saying ‘your wellbeing and comfort still depends on a well-regulated public sector’ and that will require you and us to be willing to pay more in taxes.

“Yes, rich people will be taxed more, but those of us in the middle have to be willing to pay more too. It is a necessary conversation we have to have if we want the standard of services we desire.”