Continuing Health Care and Social Services in the United Kingdom - Case Study Example

Continuing Health Care and Social Services In the United Kingdom (1900 to 1990) Historical Background of the British Poor Laws (1900 to 1945) The Poor Laws has a long history in English and later, in British domestic policies. It was developed and maintained for many centuries until the Second World War to provide relief for the poor and to other marginalized sectors of the English/British society (although this was not emphasized) (Poor Law, 2007). The originals laws (drafted by royal commissions under the authority of the parliament) provided relief, which included health care for the elderly, sick, and infant poor. Work for the able-bodied was also a part of the provisions of the Poor Laws. In the 1830’s, the extent as well as the applicability of these laws were severely hampered. The “work for the able-bodied” provision was removed because British society at that time saw poverty among the able-bodied as a moral failure (Poor Law, 2007). The government at that time emphasized increasing labor productivity through regular employment. Thus, stimulating worker to seek employment was a better option than providing them much needed economic necessities. From 1930 to the early half of the 20th century, several legislations were introduced in the House of Commons which called for the abolition of the Poor Laws. A comprehensive system of public welfare services was introduced as part of the government’s efforts to alleviate poverty through responsible economic planning. The Poor Laws, although became unnecessary at the latter half of the 20th century made few contributions in health care in England and Wales. Hospitals, orphanages, hospices, and old age homes were reconfigured to suit the social conditions of both English and Welsh societies. However, because of rampant colonial wars, migration, and to some extent high mortality rates, the British parliament saw the problem of poverty as pressing and important. It was at this time that English and Welsh society experienced what demographers call “inverted pyramid matrix.” A significant portion of the population was aged 60 above. This presented a big problem for the British parliament. Providing assistance to a significant portion of the population could severely raise the budget deficit of the government. Thus, there was a need to reconfigure health care institutions in both England and Wales. This reconfiguration should be made in accordance with the revised poor laws in 1834; that is, an inter-horizontal cooperation between key government agencies tasked to alleviate poverty in the country was the recognized essential element of success. Thus, the government called for a massive rehabilitation. It was participated by social workers, medical practitioners, reformers, and even social theorists. The general purpose of the rehabilitation was to eliminate the inefficiencies of the old health care institutions created by the Poor Laws Amendment of 1834. Nonetheless, because of the growing salience of the social sciences (and its approaches) in implementing domestic policies, especially those which concerned about poverty and unemployment, it was believed that poverty and unemployment could be remedied scientifically. Social responsibility and community awareness were emphasized; giving the marginalized sectors of English and Welsh societies some measure of political and social power. Thus welfare theory and welfare practice in the beginning of the 20th century became a set of inconsistent (most of the time contradictory), affluent, and productivity deficient policies. The purpose of the poor laws ended up in vain. Although the poor were able to receive low-cost medical services and unemployment packages, it presented a huge burden on the part of the government. The government was faced with almost feeding a significant portion of the population, without a corresponding increase in economic productivity. Thus, the Liberal Government of 1906-1914 introduced several legislations to provide social services without the stigma of the Poor Law. Only Old age pensions and the so-called National Insurance were retained in the new legislations. From that time, only fewer people were covered by the new system. Means tests were created from 1920 to 1940 as part of an attempt to provide relief without the effect of the stigma of pauperism (a psychological stance wherein the individual refuses to work in the assurance that he/she will receive support from the government). The Local Government Act of 1929 abolished Unions and Workhouses and transferred their roles to the country councils and boroughs. The final abolition came in 1948. Partnership between Health and Social Services It can be said that under the Poor Laws, health and social services were combined in an effort to extend support to all the marginalized sectors of the British and Welsh societies. A prominent British historian, Lynn Hollen Lees noted that most of the time elite families, charities and the state combined their efforts in providing relief to the poor (Lees, 1998). According to this historian, philanthropy became the byword of 19th century Britain, as it dispensed more money annually than the poor laws. Added to that, trade unions and friendly societies became active in providing the poor group insurance and modest pensions. Charitable institutions diversified their roles, resulting in the creation of professional organizations with more rigid and narrow aims and procedures. The idea of creating professional organizations with narrower aims and procedures was a general strategy of charitable institutions in effectively and efficiently catering to the needs of the poor. Thus, professional organizations were simultaneously established for the elderly, disabled, the worker, and the poor children (Lees, 1998). The general aim was to maximize the potentially scarce economic resources of the 19th century England and Welsh (since most were funneled to the war chest by the government). Activism also became a dual social phenomenon, combining politics with welfarism. Thus, it can be said that during this time, health and social services were perceived as one effort to alleviate the poor from their miserable, economic condition. Nonetheless, because health care and social service organizations were the direct products of the diversification of various charitable institutions in both England and Wales, a strong partnership between the two was developed (Lees, 1998). The National Assistance Act of 1948 and Other Related Legislations The National Assistance Act was promulgated in the British Parliament on July 5, 1948. Its general purpose was to terminate the existing law (poor law) and to provide assistance to persons in need as determined by the National Assistance Board and by local authorities (National Assistance Act 1948, 2005). Provisions were laid down calling for the welfare of the disabled, sick, aged and other persons. Homes for disabled and aged persons as well as charitable institutions for disabled persons were also regulated. Specifically, the new law provided for the general abolition of the existing poor laws. Health and social assistance were primarily transferred from the national government to local authorities. The same act also called that any accommodation or services determined by legislation of the national government shall become supplementary functions of local government units. The Secretary of State was authorized by the act to approve any action made by local officials in establishing resettlement projects (National Assistance Act 1948, 2005). The same official was also authorized to direct local authorities to make arrangements to persons who are in urgent need of residential accommodation (for persons aged 18) in cases of illness, old age, disability and other situations that hamper a person to function normally. In relation to health services, the Health Secretary was authorized to approve the establishment of a national health infrastructure which aimed to provide an efficient and medically effective network of medical institutions in the country (National Assistance Act 1948, 2005). The same official was also tasked of approving plans by local officials in raising the compensation of healthcare workers and medical professionals. Thus, with the passage of the National Assistance Act in the halls of the British Parliament, the National Health Service was born. The Minister of Health, Aneurin Bevan (a Welsh) was recognized as its founding father and chief architect. Before the institutionalization of NHS, health care was provided on a piecemeal and patchwork basis; that is, the law required people to pay directly for primary and hospital care services they receive. Thus, many people were not able to procure some of the health services offered by public and private medical and health institutions. The NHS was then established on four principles: 1) free at the point of delivery, 2) comprehensive (that is, covering all sectors of the society), 3) equity, and 4) equality. The general aim of the NHS was to promote “the establishment of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness” (Introduction to NHS Wales, 2005). This was a reaction to the growing elderly population of the country and social pressures on the old health care system in the last 100 years. The National Health Service then provided the majority of healthcare in England. Primary care, in-patient care, dentistry, and other medical services were covered by the NHS through subcontracting. Subcontracting served as the means for the government to provide the cheapest and yet the most effective system of medical care in the country. It aimed to compete with private medical institutions by providing the British public a wide array of medical health options. Hence, Nigel Lawson, a former Chancellor of the Exchequer, once called the NHS as the “national religion.” Added to that, a large portion of NHS services were given free of charge to patients. The costs though of running the NHS were taken from general taxation. The Department of Health, headed by the Secretary of State for Health, is the one responsible for running the NHS. Other legislations were introduced in the British parliament to extend, supplement, or strengthen some of the provisions of the National Assistance Act of 1948. In 1988, the British Parliament passed the so-called “Access to Medical Reports Act.” Its general purpose was to establish a right of access by individuals to medical reports related to themselves provided by medical practitioners or healthcare professionals for the purpose of employment or insurance. The said act made clear that the right to access to medical reports is a necessary step in the economic development of an individual. In the same year, the so-called “Community Health Councils Act was passed in the parliament. Its general purpose was to provide access by the public to meetings, certain documents and information related to Community Health Councils and committees. The said act recognized the indispensability of public health documents in promoting health awareness to the public. In 1983, the Mental Health Act was passed to provide a more comprehensive and efficient framework to mental health care services through the country (The Mental Health Act 1983, 2007). Specifically, the act provided that persons with severe mental health problems should be compulsory admitted to hospitals. Consent to treatment, the right to appeal, guardianship, and the patients’ involvement in criminal proceedings were fixed with safety nets. Other legislations, too long to be mentioned in the paper, were passed in the British parliament from 1948 to 2005 that catered to the needs of the public in terms of health and medical care. Universalism There is a common notion that European social and health policies are characterized by universalism based on the assumption that social and health rights are to be granted to everybody, without the speck of group or racial discrimination (WLODARCZYK, 2007). Thus, following from this assumption, rights concerning health, specifically right to health protection and the right to health care, should be treated as universal rights. Thus, all forms of social exclusions should be treated as basic violations. Adherence to universalism then heightens the roles of both the government and the citizenry in promoting solidarity. Solidarity is the notion that individuals and governments can work together in promoting all aspects of development: social, economic and political (WLODARCZYK, 2007). In this case, however, what is at stake is social development through the strengthening of the health care system. Thus, it should be noted that in countries adopting a National Health Service systems, it is quite clear that it is the citizens who are entitled to health care. Health care can only be procured so long as an individual is a citizen of the country. Benefits, medical packages, as well as public health insurance can only be provided to citizens. In Britain, for example, the establishment of NHS was designed to promote solidarity among all sectors of the British society. Thus, universalism is not just a silent declaration of “fundamental medical right” to patients; it implies the general role of citizenship in promoting solidarity to all sectors of a given society; in this case, that of the British society. Contributions of Beverige, Rowntree, and Bevan to the Formulation of the Concept of Universalism (in relation to healthcare services) There is the difficulty of establishing the direction of causative dependency networks to social depravity. Social depravity means the exclusion of some social and economic resources to a given population portion, unintended through policies or acts made by a government. In a report, Beverige outlined some of the social evils that plagued (and continue to plague) modern societies as well as their mutual reinforcements. In the report, it was indicated that poor health is a direct indicator of poverty, ignorance, and unemployment. Because some people were incapable of procuring the best medical services offered by the private sector (it was always assumed that the private sector provides the better medical services than the government), they became entrenched in poverty. Poor health, as what the report indicated, is a factor in reinforcing poor labor productivity. Poor labor productivity then reinforces or at times increases poverty. Following from this line of thinking, the propensity of experiencing poverty through an inefficient, ineffective, and narrow health care system is an indication of social deprivation, or as what other authors said, social exclusion syndrome (WLODARCZYK, 2007). Thus, Beverige’s Report became one of the major tenets of the concept of universalism. This gives light to the previous discussion of universalism. In order to promote solidarity, the basic issue of public health should be addressed; as it is the major determinant in promoting all aspects of development of a given country. A country (like the United Kingdom) that provides an efficient and effective health care system can build a citizenry that is committed to increasing labor productivity (thus economic development) and is, in some, ways immune to the effects of the so-called “social exclusion syndrome.” The development of the concept of universalism can also be attributed to the work of Seeborn Rowntree entitled “Poverty, A Study of Town Life.” In Chapter 5 of his book, he outlined some of the immediate causes of poverty. Here are as follows: 1) death of the chief wage-earner, 2) incapacity of the chief wage-earner through illness, old age, or accident, 3) unemployed chief wage-earner, 4) chronic irregularity of work or unemployment, due sometimes on the unwillingness of a worker to undertake regular employment (the stigma of pauperism caused by the Poor Laws in England and in Wales), and 5) lowness of wage (Rowntree, 1902:119). Like Beverige, Rowntree recognized that the physical means of a worker to continue working is determined by his/her health. Specifically, he was able to prove that the greatest opportunity of a worker to save is after he reached manhood and before marriage. At this period, the worker expends a great amount of energy in raising his/her labor productivity. In old age, the worker becomes less productive and hence drives his/her working ego down, making him/her vulnerable to social ills (as had been outlined by Beverige). Thus, unknown to Rowntree, his analysis became also a major foundation of the concept of universalism. Providing an efficient and effective health care service will generally improve worker’s labor productivity even after marriage (and more or less stable in old age). The worker will not be able to feel the effects of the social exclusion syndrome. And his willingness to work even at times of economic distress will be retained (although this is debatable). The founder of NHS in Britain can be described as the modern progenitor of the concept of universalism. In fact, the four principles which had been outlined previously are the main characteristics of universalism. At a meeting of health ministers in Copenhagen, Denmark, in 1950, Aneurin Bevan explained the four guiding principles of the British NHS system. Because building a strong citizenry demands a strong health care system, it must be free so long as it is meet from the general taxation. It must also be comprehensive; that is, all sectors of the society can avail of the medical services offered by the state (the emphasis was on the state rather then on government – to indicate that the NHS cut across political parties and alliances and established on a long-term basis). Added to that, the state should provide the public a wide array of medical services in recognition of the fact that the people have the right to avail to all forms of medical and health care services. Nonetheless, a strong health care system should be characterized by equity; that is, payment for medical services must be determined by the patients’ income or capacity to pay. The most recognized characteristic of a strong health care system is equality. All people from all walks of life are recognized as the bearers of rights concerning health, specifically those related to health protection and the right to health care. The state must recognize its fundamentality (as what the concept of universalism denotes). Health and Social Care Divide: Policy Trends from 1945 to 1990 Health and social care were generally integrated domestic policies of the British government after the abolition of the Poor Law in 1945. The proximity of the two domestic policies was recognized by different governments who exercised power during this period. Structural changes were discernable though. The Labor government after the Second World War initiated steps in strengthening the NHS through a conglomeration of a supplementary system of welfare policies, designed to deliver the best possible arrangements of social services to the British public. Right-wing political parties criticized the Labor government for overemphasizing the role of the state in the providing the people with low-cost medical and social services at the cost of the government coffers. Specifically, increasing the budget for social and health services would drive taxes high. This would generally slow down the economy and drive investors out of the country. Thus, when the Conservative Party won the parliamentary elections in 1979, the Prime Minister, Margaret Thatcher, began removing some of the “unnecessary” programs of the previous government. She argued that while responsible redistribution is an important factor in strengthening the NHS, it must be concomitant with existing neoclassical economic policies. Overspending on social and health services would certainly drive labor productivity down (presenting another pauperism scenario). Thus, she advocated a more “prudent” approach in managing the NHS. She also called the private sector to participate in the efforts of the government in strengthening the health and social services of the country. Thus, policy trends of the health and social services divide from 1945 to 1990 were characterized by fiscal arrangements and to some extent bureaucratic streamlining. No change in content was observed. Bibliography Community Health Councils Act 1988. (2007). Crown Copyright. Available from: http://www.opsi.gov.uk/acts/acts1988/Ukpga_19880024_en_1.htm [Accessed 11 October 2007]. Introduction to NHS Wales. (2005) September 12. Available from: http://www.wales.nhs.uk/sites3/page.cfm?pid=11593&orgid=452 [Accessed 11 October 2007]. Lees, L. (1998). The Solidarities of Strangers: The English Poor Laws and the People, 1700-1948. Pennsylvania, University of Pennsylvania. National Assistance Act 1948. (2005). David Swarbick. Available from: http://www.swarb.co.uk/acts/1948National_AssistanceAct.shtml [Accessed 11 October 2007]. Poor Laws. (2007). Britannica Concise Encyclopedia. Available from: http://www.answers.com/topic/poor-law [Accessed 11 October 2007]. Rowntree, S. (1902).Poverty: A Study of Town Life.  London, Rowntree Charitable Trust. The Mental Health Act 1983. (2007). Available from: http://www.cambsmentalhealthinfo.nhs.uk/services/sthcambs/the_mental_health_act_-_sectio.html [Accessed 11 October 2007]. WLODARCZYK, W. (2007). Report on Social Cohesion and Quality of Life. H.D.S.E. Available from: http://www.coe.int/t/e/social_cohesion/hdse/2_hdse_reports/2_thematic_reports/Report%20on%20Health.asp [Accessed 11 October 2007]. Read More