Social Policy With Reference to Social Security - Essay Example

Social Policy With Reference to Social Security This essay will look at the social conditions that existed for each οf the political parties and the welfare policy approaches that each party adopted in relation to the NHS. Initially I will look at Social Reformist policies followed by Market Liberals. But as a consequence οf the research the essay will demonstrate that New Labour has used a collaboration οf existing ideologies to create a set οf welfare policies, which they claim are relevant to meeting the needs οf the NHS in the 21st Century: 'The practise οf what is known in the business world as 'brokerage politics' or 'dealer politics - adopting the opposition's best policies'. (Jones, 2000 p.199) The Second World War for the general population was an experience that was more extensive and indiscriminate than οf any previous conflicts. Previous wars had mostly been fought far from Britain. The Blitzkrieg, the war by air, changed this. It destroyed millions οf homes and forced people from the cities to flee to the countryside, bringing together people from different classes and backgrounds. It had been an intense and traumatic time for the entire nation but also a realisation that misfortune and tragedy were not restricted to the disadvantage alone. The task οf re-building the state needed to take place at every level, as well as the re-building οf lives: 'Lives was shortages οf everything - food, even bread and potatoes, clothes, transport, accommodation' (Jones, 1991 p.121). This led to a great expansion in the role οf Government in society. Historically British social policy had been dominated by the Poor Laws. But now there was widespread support for reform and expansion οf the welfare system. Development οf such reforms would owe much to Fabianist beliefs and the Beveridge Report 1942. William Beveridge was appointed by the wartime Government to review Social Security Policy. His report concluded that the state should meet collective welfare needs and provide positive freedom to individuals by removing the Five Giant Evils. In 1945 Labour began addressing Beveridge's evil through state action introduced reforms: 'The National Health Service was set up to combat Disease. Full Employment to combat Idleness. State Education to fifteen to combat ignorance (actually introduced by the war time government). Public Housing to combat Squalor. National Insurance and Assistance Schemes to combat Want.' (Jones, 1991 p.126) Claiming: 'Our policy was not οf reformed capitalism, but progress towards a democratic socialism...the war had shown how much could be accomplished when public advantage was put before private vested interest. If that was right in wartime, it was right in peacetime' (Jones, 1991 p.117). To describe the social policy reforms, press at the time coined the phrase 'from the cradle to the grave'. Alcock describes the social policy proposals as: 'The social policy response to the depravation οf depression' (Alcock, 2003 p.220). Prior to the NHS, health care was not a luxury everybody could afford. Access to a doctor was free to workers but this did not cover their families. Poor people often went without medical treatment, relying on home remedies or on the charity οf a doctor. For the Government to fund the NHS and other evils economic growth and full employment were essential. Maynard Keynes advised the government to spend its way out οf a recession by lowering taxes and investing more in projects and programmes. Government began to use Keynes theory οf demand management and in 1946 Minister Aneurin Bevan navigated proposals for the NHS passed two years earlier through parliament. The NHS became reality on 5 July 1948 and provided a service which was: 'Free at the point οf delivering to the patient'. (Alcock, 2003 p.62) The result οf social and economic policy approaches was as Keynes predicted economic growth with little unemployment. Professor Titmuss described the social policy achievements οf this period: 'By the end οf the second world war, Government had through the agency οf new established and existing services, assumed and developed a measure οf direct concern for health and well being οf the population which, by contrast with the role οf government in the 1930's was little short οf remarkable...it was increasingly regarded as a proper function or even obligation οf Government to ward off distress and strain among not only the poor, but almost all classes οf society'. (Jones, 2000 p. 104) For the next 30 years the NHS continued to operate in much the same way as at its conception. The accepted basis οf policy was that a range οf publicly provided benefits and services should be available to all on demonstration οf need and, in the case οf services, frees at the point οf receipt. Professor T.H. Marshall οf the London School οf Economics in 1965 summed up this accord: 'There is little difference οf opinion as to the services that must be provided, and it is generally agreed that whoever provides them, the overall responsibility for the welfare οf the citizen must remain with the state'. (Jones, 2000 p.144) However the economic crisis οf 1967 forced the Government to cut spending as the sterling devalued. Yet costs οf sustaining the NHS spiralled resulting in the first major rethink οf the Welfare State. Avenues through policies were being found to limit costs on an ever-expanding service. The view οf the Beveridge Report was that demand for the service would not exceed the ability οf government to provide and pay for it: 'Demand for the services was finite and that if financial resources could be ring- fenced to allow specific and new health care problems to be addressed and alleviated, expenditure could be self limiting'. (Gormley, 1999 p.41) This proved to be wrong. Anti- collectivist arguments were voiced such as the Child Poverty Acton Groups: 'Freedom involved choice, not state monopoly, competition meant greater efficiency. Britain must shake off the shackles οf the socialist reformist bureaucracy. State Welfarism was restricting choice and strifling enterprise'. (Jones, 1991 p.169/170) In addition to cuts a re-organisation οf the NHS tripartite structure was hoped would bring about a more efficient service. In 1972 the Conservative's Final White Paper led to the NHS Reorganisation Act. The following year increases in oil prices had a profound effect on the economy: 'The increase in oil prices added £2.5 billion to Britain's current account deficit, increased the cost οf living by 10%, and reduced the Gross Domestic Product by 5%, all in a single year'. (Jones, 1991 p.186) In 1974 the Sterling Crisis made economic matters worse. Furthermore, inflation and unemployment, which had remained generally at 500,000 for the previous three decades, began to rise as a result οf the recession. The Government was forced to ask the IMF for a loan which was granted on the condition cuts on public sector expenditure were made, in effect ending Keynesianism. Keynes had also ignored the power οf Trade Unions who during the 70's had a wave οf strikes all having a huge impact on public services: 'Sick people were refused hospital admission, water supplies became polluted, bodies remain unburied, sacks οf rubbish piled up in the streets and children were sent home'. (Jones, 1991 p.189) Press described this period as the 'Winter οf Discontent'. The consensus on the Welfare Sate was now divided. New Left οf Labour were criticising the Fabian domination οf policy and New Right Wing politics wanted to return to the: 'Laissez-faire state and self protecting families and communities'. (Alcock, 2003 p.10) And 'Their main argument was that state intervention to provide welfare services, and the gradual expansion οf these which Fabianism sought, merely drove up the cost οf public expenditure to a point at which it began to interfere with the effective operation οf a market economy'. (Alcock, 2003 p.10) In 1979 Labour had failed to control the economy. The theory οf Hayek and the introduction οf monetarism under Margaret Thatcher replaced Keynes theory οf Government intervention and full employment. According to Hayek Government intervention had lead to inefficiency. To tackle the problems described the Conservatives cut back on expenditure and aimed to provide conditions in which the market could regulate itself thus: 'Government may largely withdraw from the area οf social policy, leaving consumers to make discussions with a minimum οf public service intervention'. (Jones, 1991 p. 190) Thatcher wanted to 'Roll back the State' and reshape Britain in a new frame οf reference: 'Individividualist rather than collectivist' (Jones, 1991 p.189). Thatcher complained about the dependency environment the Welfare state had created and how Government needed to move away from the 'Nanny State' by: 'Stressing the values οf self help and enterprise rather than those οf community and social concern' (Jones, 1991 p. 189) In relation to the NHS the 1979 Conservative manifesto stated: "We do not intend to reduce resources going to the NHS". (Conservative Manifesto 1979) In sharp contrast to this statement the NHS was equally included: 'In 1983 it was estimated that the amount spent on management in the NHS had fallen from 5.12% οf the total budget in 1979-80 to 4.44% in 1982-83, representing a saving οf £64 million'. (Ham, 1992 p.32) Administrative improvements were made in the NHS outlined in the Governments publication Patients First. Area Health Authority was replaced with District Health Authority's. Annual Reviews and Performances Indicators were introduced. The Government supported private health care as an alternative. The Health Services Board that regulated the activity οf the private sector was abolished, consultants' contracts were changed allowing more private practice and the income limit on tax relief on private health insurance was lowered. Resulting in an increase to the number οf subscribers to private medical insurance: 'By 1989 the number οf people in the UK covered by private health insurance totalled over 7 million, around 13% οf the population'. And 'By 1989 there were 200 private hospitals in England, providing 7% οf all acute beds...treated approximately 8% οf all inpatients...carried out 17% οf all elective surgery...proportion οf waiting lists done privately increased from one-eighth in 1981 to one-sixth in 1986'. Finally 'In tandem with the growth οf private acute hospitals there has been a rapid extension in private residential and nursing home provision for elderly people and other vulnerable groups'. (Ham, 1992 p.47) Domestic, catering and laundry services were contracted out. The assumption being that competition would be introduced and the private sector would provide more cost efficient service. In 1983 the Conservatives were re-elected claiming that the NHS was: 'Safe in our hands' (Margaret Thatcher 1983) The Government began by recruiting Sir Griffith; director οf Sainsbury's to examine the use οf management, manpower and related sources in the NHS. His report concluded that the lack οf clear line management hierarchy in the health service had led to inefficiency and unaccountability. Government sought to remedy this failing with a series οf proposals such as the recruitment οf managers from industry. In 1987 the government faced much criticism over the underfunding crisis that hit the NHS Thatcher responded by providing £101 million and with a review οf the NHS. But attention on efficient use οf the service was still important. Οf particular interest was Professor Enthoven suggestion οf encouraging service providers to compete for patients thus creating markets in the NHS. In 1989 the Government published Working for Patients proposing the establishment οf quasi-markets. These changes were incorporated into the NHS and Community Act 1990 and the introduction οf the purchase/provider divide was created. By the late 80's the scope for managers to contract out included quasi-clinical services. The general management changes οf the mid-1980s were strengthened and doctors became more accountable through general managers. New contracts for G.P.s came into effect in April 1990 (originally proposed in the White Paper Promoting Better Health). They included targets for preventative work, and practices to produce annual reports amongst other things. In 1997 New Labour came to power claiming that socialism was no longer a viable approach to economic organisation, yet the enthusiasm, for free market favoured by Conservative was also flawed: 'The Third Way is more decisively beyond Old Left preoccupied by state control, high taxation and producer interests, and a New Right treating public investment, and often the very notions οf 'society' and collective endeavour, as evils to be undone. (Tony Blair 1998) New Labour believe that globalisation: 'A process whereby political, social, economic and cultural relations take place on a global scale with profound consequences for individuals, local experiences and everyday lives'. (Giddens, 2001 p.212) A new innovative and powerful form οf politics is vital as Nation States more than ever playing an increasingly dominant role on the world stage. Giddens agrees that the modernising agenda οf Third Way politics has adapted: 'Social democracy to a world which has fundamentally changed over the past two or three decades'. (Giddens, 1998 p.26/27) And that: 'Third Way politics looks towards a 'society οf care' while acknowledging that old forms οf welfare were often unsuccessful in reducing inequalities and controlled, rather than empowered poor'. (Giddens, 2001 p.437) The priority for New Labour for its first two years in office was to ensure a stable economy by adhering to the fiscal constraints οf the previous administration. In December 1997 the Government published The New NHS: 'The White Paper marks a turning point for the NHS. It replaces the internal market with integrated care'. (Tony Blair 1997) Which would be more collaborative, quality based approached combing efficiency, quality and partnership. In 1998 the publication οf Modern Public Services for Britain followed stating longer term planning through targets between the Treasury and the Department οf Health. Then the Health Act in 1999 where New Labour claimed to replace the internal market with co-operation and partnership with the creation οf Primary Care Trusts. It is here that New Labour policies on the NHS undoubtedly start to show continuities with previous policies. The Government had abolished Fundholding by GP's but set up commissioning authorities, which still meant a separation between providers and purchases. The first crisis for New Labour in the NHS came during the winter οf 1999 when the NHS struggled to cope with winter pressures. New Labour promised an injection οf money linked to far reaching reforms. Although this increase in funds was certainly welcome its net effect was to restore spending to the level that it had reached in 1993 (approximately 39 per cent οf GDP): 'Tough inflation, prudent fiscal and monetary policy, low taxes and low public spending were all policies οf the outgoing Tory administration and now they are the policies οf Blair's Labour' (Driver and Martell, 1998 p.66) In July 2000 the NHS Plan was published detailing Government reforms. New Labour re-iterated their promise to spend more on the condition οf improvements and thus expanded the Conservative policy οf testing the quality and performance οf Health Services. It was not until 2002 that detailed plans to take forward the NHS emerged. First the Wanless Report into the future funding οf the NHS was published leading to the Governments decision to invest an extra £40 billion in the NHS between 2003 and 2008. Secondly the publication οf Shifting the Balance οf Power meant resources would be devolved to local level, another similarity to Conservative policy. Lastly the proposal οf Foundation Hospitals and a new system οf financing hospitals. New Labour again showed similarity as well as a break with previous policies. The acceptance οf a mixed economy οf care provision within the NHS was created under the Conservatives internal market. Foundation hospitals work on the same basis but unlike previous reforms this will not be limited to competition within the NHS. Any international company will be able to bid for NHS work, form partnerships with, or even manage foundation hospitals. These trusts will be first to earn income according to how many people they treat. This change alone will be the first to earn income introduce incentives. At the same time Foundation Hospitals can borrow money from the private market, sell surplus hospital property and keep the proceeds. Re-engineering οf the NHS under New Labour was inevitable but the Government is looking to make these changes through Foundation Hospitals and the promotion οf Private Finance Initiatives (PFIs), which had originally been introduced under the Conservatives. New Labour claims the partnership with PFI will be the biggest hospital programme in the history οf the NHS. New Labour feels that PFIs are acceptable and important way forward for the NHS: 'Private sector is part οf family' (Health Secretary Milburn, Independent Times, 7/12/01 p.9) Critics οf these policies have accused New Labour οf creeping privatisation οf the NHS like their predecessors the Conservatives. In conclusion, New Labour and its supporters have repeatedly declared that their policies are a response to the needs οf a changed world in the 21st Century. But when you look at the NHS policies οf New Labour in relation to the NHS the essay has been able to prove it is in no way unique. New Labours approach can be found throughout the welfare policies οf other political parties Britain, Europe and America, where a compromise or a third way has always been sought to the problems οf that particular time. Some would argue that New Labour responds to the needs οf the 21st Century but neither are they New or Labour policies: 'Forget the Third Way, now it's the Third Phase' (Political Editor Andrew Grice οf Independent Times, 13/03/2002) References Alcock, P. (1996). Social Policy in Britain: Themes and Issues. Basingsoke : MacMillan. Alcock, P. (2003). Social Policy in Britain Second Edition. Palgrave : MacMillan. Alcock, P. (2003). The students companion to Social Policy Second Edition. Oxford : Blackwell. Blakemore, K. (2003). An introduction to Social Policy Second Edition. Open University Press. Ham, C. (1992). Health Policy in Britain Third Edition. MacMillan. Independent Times. 07/12/01 p.9 and 13/03/2002. Giddens, A. (2001). Sociology Fourth Edition. Polity Press in association with Blackwell Publishers. Glennerster, H. (2000). British Social Policy since 1945 Second Edition. Blackwell Publishers. Gormley, K. (1999). Social Policy and Health Care. Edinburgh : Churchill : Livingstone. Jones, K. (1991). The making οf social policy in Britain 1830-1990. The Athlone Press. Jones, K. (2000). The making οf social policy in Britain: from the Poor Law to New Labour. The Athlone Press. Read More