The Labour party may have won a landslide election victory in the UK last month, but now comes the difficult and unforgiving business of governing, not helped by the discovery of a £22bn black hole in the public finances. Significant voter discontent centred on the sorry state of hollowed-out public services, especially the NHS. With ever-longer waiting lists for hospital appointments, voters on both the left and right are hugely concerned about the health service. Nigel Farage, leader of the rightwing Reform UK, is ready to exploit any public discontent over the state of broken public services and has loudly spoken of his desire to win over Labour voters. Keir Starmer is the first centre-left leader to win a UK election since Tony Blair, who won on a sweeping mandate to modernise Britain. This time, things are different. While Labour won two-thirds of parliamentary seats, it received just over a third of votes, and much of Labour’s success came from widespread discontent with 14 years of Tory rule. Starmer has promised British voters that change starts now, but when it comes to the NHS, Labour faces a daunting task. Restoring confidence in the health system will be a long, difficult and costly road in a country faced with a mixture of sluggish growth, labour shortages and weak public finances. In a recent study we at Boconni University and the London School of Economics examined the political consequences of declining NHS performance. By analysing government data on closures of local healthcare facilities and linking it to data on public preferences and voting intention, we found that closures increased people’s dissatisfaction with the health service and resulted in increased support for Reform (and its predecessors, the Brexit party and Ukip). Moreover, the link between the shutting down of local healthcare facilities and Reform support is highest in areas that have experienced increased immigration and registrations of migrants at local GP practices. These results could spell serious trouble for Labour if NHS services continue to face cancelled appointments, cuts and closures. We have seen the results of slashed public services in other parts of Europe. In Italy, hard-right parties have enjoyed electoral success for longer than anywhere else in Europe. A study from 2023 showed that in Italy hard-right gains in government have occurred in step with public service cuts and closures. In 2010, an administrative reform forced municipalities to shut and merge local public services, to the detriment of residents. Some “native-born” citizens then saw themselves as pitted against immigrants in a zero-sum competition for access to essential public services. This research found that broken promises and underfunded public services deepen discontent, and if people feel that the state can no longer adequately provide for their needs they experience profound discontent. This has proved fertile ground for the hard-right to exploit by pledging to restrict immigration and immigrants’ access to local public services. As a result, this boosts support for rightwing parties. But it’s not just in Italy and the UK that crumbling public services are keenly felt. Across a great swath of rural France a sense of neglect prevails and has fuelled a turn to the right leading to an upsurge in votes for Marine Le Pen’s hard-right National Rally. Similarly, in the Netherlands the rhetoric of Geert Wilders, leader of the election-winning Freedom party, includes opposition to cuts to public services alongside anti-immigration sentiment. The UK’s Reform party, like many populist hard-right parties in Europe, frame access to public service as a zero-sum game between “native” and “migrant” populations, and attribute blame for deteriorating public service delivery to the latter. So fixing the most urgent problems in the NHS will be key to stemming the tide of the populist right in Britain. The problem for Labour is that there isn’t a quick or easy solution to the challenges faced by the health service. One of its first actions has been to agree a pay deal with junior doctors’ leaders to end a 20-month dispute that had resulted in the postponement of 1.5m appointments and to increase wages for other NHS staff, yet at the same time it decided to withdraw funding for the replacement of crumbling hospitals to shore up public finances. This won’t install a huge amount of confidence among voters that the NHS is safe in Labour’s hands. And as long as mainstream parties are unable to show that they can safeguard public services, populist parties will continue to attract the support of disgruntled and ignored citizens. Yet, providing good-quality health services and keeping up with public investment is going to be a tall order when economic growth has stalled and public finances are strained. Whether Starmer’s government can satisfy public expectations will be one of the key questions during his tenure as prime minister and could be decisive for his ability to win a second term. If the British people start to feel as if their new government cares about them, and is able to restore good public services that meet their growing needs, then the far right may be kept at bay. At a time when trust in politics is low, Labour must deliver results or face the wrath of an electorate that desires – even demands – change and may turn to the populist right in the hope of achieving it. Catherine De Vries is Generali chair in European policies and professor at Bocconi University in Milan