Beveridge Report of 1942 - Essay Example

Running Head: Beveridge Report 'f 1942 Show how the Beveridge Report of 1942 made such a significant contribution to the creation of the NHS and general development of the welfare state' [Name of the writer] [Name of the institution] Show how the Beveridge Report of 1942 made such a significant contribution to the creation of the NHS and general development of the welfare state' This essay will discuss how the Beveridge Report 'f 1942 made such a significant contribution to the creation 'f the NHS and general development 'f the welfare state and will also look at the social conditions that existed for each 'f 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 'f the research the essay will demonstrate that New Labour has used a collaboration 'f existing ideologies to create a set 'f welfare policies, which they claim are relevant to meeting the needs 'f the NHS in the 21st Century: 'The practise 'f 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 'f any previous conflicts. Previous wars had mostly been fought far from Britain. The Blitzkrieg, the war by air, changed this. It destroyed millions 'f 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 'f re-building the state needed to take place at every level, as well as the re-building 'f lives: 'Lives was shortages 'f everything - food, even bread and potatoes, clothes, transport, accommodation' (Jones, 1991 p.121) This led to a great expansion in the role 'f Government in society. Historically British social policy had been dominated by the Poor Laws. But now there was widespread support for reform and expansion 'f the welfare system. Development 'f 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 'f 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 'f 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 'f 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 'f a recession by lowering taxes and investing more in projects and programmes. Government began to use Keynes theory 'f 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 'f delivering to the patient'. (Alcock, 2003 p.62) The result 'f social and economic policy approaches was as Keynes predicted economic growth with little unemployment. Professor Titmuss described the social policy achievements 'f this period: 'By the end 'f the second world war, Government had through the agency 'f new established and existing services, assumed and developed a measure 'f direct concern for health and well being 'f the population which, by contrast with the role 'f government in the 1930's was little short 'f remarkable...it was increasingly regarded as a proper function or even obligation 'f Government to ward off distress and strain among not only the poor, but almost all classes 'f 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 'f policy was that a range 'f publicly provided benefits and services should be available to all on demonstration 'f need and, in the case 'f services, frees at the point 'f receipt. Professor T.H. Marshall 'f the London School 'f Economics in 1965 summed up this accord: 'There is little difference 'f opinion as to the services that must be provided, and it is generally agreed that whoever provides them, the overall responsibility for the welfare 'f the citizen must remain with the state'. (Jones, 2000 p.144) However the economic crisis 'f 1967 forced the Government to cut spending as the sterling devalued. Yet costs 'f sustaining the NHS spiralled resulting in the first major rethink 'f the Welfare State. Avenues through policies were being found to limit costs on an ever-expanding service. The view 'f the Beveridge Report was that demand for the service would not exceed the ability 'f 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 'f the socialist reformist bureaucracy. State Welfarism was restricting choice and strifling enterprise'. (Jones, 1991 p.169/170) In addition to cuts a re-organisation 'f 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 'f 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 'f 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 'f Trade Unions who during the 70's had a wave 'f strikes all having a huge impact on public services: 'Sick people were refused hospital admission, water supplies became polluted, bodies remain unburied, sacks 'f rubbish piled up in the streets and children were sent home'. (Jones, 1991 p.189) Press described this period as the 'Winter 'f Discontent'. The consensus on the Welfare Sate was now divided. New Left 'f Labour were criticising the Fabian domination 'f 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 'f these which Fabianism sought, merely drove up the cost 'f public expenditure to a point at which it began to interfere with the effective operation 'f a market economy'. (Alcock, 2003 p.10) In 1979 Labour had failed to control the economy. The theory 'f Hayek and the introduction 'f monetarism under Margaret Thatcher replaced Keynes theory 'f 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 'f social policy, leaving consumers to make discussions with a minimum 'f public service intervention'. (Jones, 1991 p. 190) Thatcher wanted to 'Roll back the State' and reshape Britain in a new frame 'f 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 'f self help and enterprise rather than those 'f 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% 'f the total budget in 1979-80 to 4.44% in 1982-83, representing a saving 'f £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 'f 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 'f subscribers to private medical insurance: 'By 1989 the number 'f people in the UK covered by private health insurance totalled over 7 million, around 13% 'f the population'. And 'By 1989 there were 200 private hospitals in England, providing 7% 'f all acute beds...treated approximately 8% 'f all inpatients...carried out 17% 'f all elective surgery...proportion 'f waiting lists done privately increased from one-eighth in 1981 to one-sixth in 1986'. Finally 'In tandem with the growth 'f 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 'f Sainsbury's to examine the use 'f management, manpower and related sources in the NHS. His report concluded that the lack 'f clear line management hierarchy in the health service had led to inefficiency and unaccountability. Government sought to remedy this failing with a series 'f proposals such as the recruitment 'f 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 'f the NHS. But attention on efficient use 'f the service was still important. 'f particular interest was Professor Enthoven suggestion 'f encouraging service providers to compete for patients thus creating markets in the NHS. In 1989 the Government published Working for Patients proposing the establishment 'f quasi-markets. These changes were incorporated into the NHS and Community Act 1990 and the introduction 'f 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 'f 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 'f '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 'f politics is vital as Nation States more than ever playing an increasingly dominant role on the world stage. Giddens agrees that the modernising agenda 'f 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 'f care' while acknowledging that old forms 'f 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 'f 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 'f Modern Public Services for Britain followed stating longer term planning through targets between the Treasury and the Department 'f Health. Then the Health Act in 1999 where New Labour claimed to replace the internal market with co-operation and partnership with the creation 'f 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 'f 1999 when the NHS struggled to cope with winter pressures. New Labour promised an injection 'f 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 'f GDP): 'Tough inflation, prudent fiscal and monetary policy, low taxes and low public spending were all policies 'f the outgoing Tory administration and now they are the policies 'f 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 'f improvements and thus expanded the Conservative policy 'f testing the quality and performance 'f Health Services. It was not until 2002 that detailed plans to take forward the NHS emerged. First the Wanless Report into the future funding 'f 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 'f Shifting the Balance 'f Power meant resources would be devolved to local level, another similarity to Conservative policy. Lastly the proposal 'f Foundation Hospitals and a new system 'f financing hospitals. New Labour again showed similarity as well as a break with previous policies. The acceptance 'f a mixed economy 'f 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 'f the NHS under New Labour was inevitable but the Government is looking to make these changes through Foundation Hospitals and the promotion 'f 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 'f the NHS. New Labour feels that PFIs are acceptable and important way forward for the NHS: 'Private sector is part 'f family' (Health Secretary Milburn, Independent Times, 7/12/01 p.9) Critics 'f these policies have accused New Labour 'f creeping privatisation 'f 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 'f a changed world in the 21st Century. But when you look at the NHS policies 'f 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 'f other political parties Britain, Europe and America, where a compromise or a third way has always been sought to the problems 'f that particular time. Some would argue that New Labour responds to the needs 'f the 21st Century but neither are they New or Labour policies: 'Forget the Third Way, now it's the Third Phase' 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 'f social policy in Britain 1830-1990. The Athlone Press. Jones, K. (2000). The making 'f social policy in Britain: from the Poor Law to New Labour. The Athlone Press. Read More