The Welfare state in Britain as we know it was formed in the twentieth century but its origins can be traced back to mediaeval times; welfare was delivered collectively, free of the state many local churches ran hospitals; however the word hospitals should not be understood in today’s terms. In mediaeval times these places were communities. Were the sick, frail and elderly in particular were looked after. Back then Parishes in Britain had a responsibility to their poor, In 1598 Elizabeth I, passed an Act for the Relief of the Poor, this is known as The Elizabethan Poor Law. It offered the poor some protection, and less sturdy beggars were sent back to their parish of origin for help, every parish appointed overseers of the poor who were responsible for setting up parish houses for those unable of supporting themselves and finding work for the unemployed. Around the time the industrial revolution came, the rapid population growth and development of the towns, and the first experience of modern unemployment, along with this came increasing poor rates, In 1833 Earl Gray Prime Minister, set up a Poor Law Commission to scrutinise the working of the poor Law system that had been put in place in Britain. In his report published in 1834, the Commission made several recommendations to Parliament. As a result, the Poor Law Amendment Act was passed. (The poor Act of 1598 continued till 1948)
This Essay will discuss the theories in social policy, which underpin welfare provision and to what extent have these theories influenced the delivery of welfare services and met the demands of a changed and changing society this essay will also examine the welfare provision of Community care and Health.
The Poor Laws were very much disliked, a great deal of the development of social services in the 20th century including means tests, health care and national insurance were designed to avoid having to rely on them and in many industrialised societies social exclusion and poverty are alleviated to some degree by the introduction of a welfare state. The majority of industrialised and industrialising countries in the world today are welfare states, this means that the state plays a central role in the provision of welfare; it does this through a system that offers benefits and services to ensure that people’s basic needs such as Income, Housing, Education and Healthcare are meet.
The welfare state has a daunting task of managing the risk faced by people, over the duration of their lives such as: Job loss, old age, sickness and disabilities, the level of welfare services and spending vary from country to country, a number of countries have a highly developed welfare systems and allocate a large proportion of their national budget to them, over the years there are many theories and Political views on welfare and are often divided into right and left wing views over the welfare state and some have shaped the policies that we have in place today.
The right wing: is against public provision of welfare and are for residual welfare They are seen as individualist on the other hand the left wing: is for public provision of welfare and residual welfare and are seen as collectivist, however this is not so straight forwards as it first seems this might also be dependent on The positions that might be held by people. There is an individualistic left wing, and a collectivist right wing. Many right-wingers accept the principle of institutional welfare, and many left wingers are uncomfortable about institutional measures, like student grants or earnings-related pensions, which favour richer people over poorer ones, Left-wingers however support social security (which enable people to buy food in the private market) rather than soup kitchens (which are more of fern than not publicly provided). The main political perspective of welfare positions are: The Marxist, The Conservatism and The Liberal individualism.
Marxist core beliefs are that welfare concentrates principally on its relationship to the exercise of power. Marxist argues that welfare has been developed through the strength of working-class resistance to exploitation they further argue that the state can be seen as an instrument of a complex set of systems which reflects the contradictions of the society or as a ruling capitalist class or at least a pert of it.
Conservatives core beliefs lie in the importance of the social order. This is reflected in a respect for tradition, an emphasis on the importance of religion, and a stress on the importance of inequality – such as inequalities of caste or class – Conservatives believe that Welfare is a secondary issue and the basis for structured social relationships.,
The Liberal individualism:
Liberalism believes that the premise that everyone is an individual, and that individuals have rights. They mistrust the state and they also believe that society is likely to regulate itself if state interference is removed. The liberalism central core belief is freedom. All freedoms are not equally important; their main values and concerns are with certain particularly important freedoms, such as freedom, of worship, of speech, and. of assembly.
The welfare state stretched further under the pre First World War, from the outset the Liberal government’s principle emerged that the state should eliminate the worst causes of poverty and introduced a number of policies these included: Health, Housing, Education, Pensions and unemployment insurance and minimum wage boards and other measures on a strictly limited scale, these minimum standards had been introduced to give a basic level of assistance which was assumed no one would be allowed to fall below, the principle of a national minimum standard of life looks very different today form how the legislations and public policy was originally formulated, it was an attempt to prevent destitution and to deal with poverty. In 1911 the first National Health Insurance Act was passed, Lloyd George, Liberal Chancellor of the Exchequer assured employers it would ease the unsettled workforce and in turn would raise productivity by reducing sickness absence. World war one put a temporarily halted workers’ growing militancy. With the women’s work force increased the factory workers produced an even greater mood for change and with the horrific suffering soldiers coming home from war blind and with out limbs other suffering from mustard gas poising, In 1917 Lloyd George, by now prime minister, warned: that the Russian revolution has already inspired workers across Europe. Lloyd George Argued “The working class will be expecting a really new world. They will never go back to where they were before the war”. He promised a “land fit for heroes”, he was hoping to convince workers that life would improve without them following their Russian cousins.
In today’s society we have been increasingly aware of the many diverse needs of people needing help from a partly or non finical kind these would include: the blind, the deaf, long term sick and the handicapped, single parent families, unmarried mother, and newly arrived emigrants est. Although the principle of a national minimum standard of life is still in place it has immensely improved in comparison over the last 90 years.
The British political history of social policies since 1940’s have been many and varied, before the 1945 elections some new social policies had already been put in place there were three critical developments that took place during the second world war, the early drive towards the establishment of a national health service, the Beveridge Report and the Butler education act of 1944.
The Beveridge Report one of many efforts to plan for the forthcoming peace, it was widely acknowledged within Coalition Government that after the war Brittan would need to rationalise and improve its income maintenance policy; the report itself was a combination of detailed proposals for a comprehensive social insurance system and significant needs for future social policy.
Beveridge” described the road to social reconstruction after the war as involving ‘Slaying the five giants’ of’ Want, Disease, ignorance, squalor and idleness”.
The report had set down, had three conditions that were necessary to the development of a satisfactory system of income maintenance. The introduction of setting up a comprehensive health and rehabilitation service, a system of family allowance and the maintenance of full time employment, at the time these accompanying conditions made more political impact than the social insurance proposals.
The Beveridge Report (1942) The Beveridge Report launched the introduction of the Welfare State. The core reforms included:
The Education Act 1944 – provided free secondary education for all children.
The Family Allowances Act 1945 – provided universal benefits for families with two or more children.
The National Health Service Act 1946 – provided free and universal health care.
The National Insurance Act 1946 – provided unemployment and sickness benefits.
The Children Act 1946 – gave local authorities to set up social work for children.
Beveridge social insurance proposal involved flat rate benefit payments to the unemployed, widows, pensioners and the sick. This was a fixed amount for individuals with additions made for dependants with no graduation In relation to past earnings however this was to be funded by flat rate contributions from the insured, their employers and the state.
On the 5 July 1948, The National Health Service started (The National Health Service Act 1946) The NHS was based on principles unlike anything that had gone before in health care. It was a historic achievement; however at that time majority of doctors were opposed to the idea, they believed that they would lose money as a result of it. Their belief was that their professional freedom would be jeopardised i.e. Doctors believed they would treat fewer private patients and the outcome meant they would lose out financially. Added to this was a strong belief that the NHS would not allow patients to pick their doctor however this was not to be the case and 95% of all of the medical profession joined the NHS. Others countries at that time still tended to rely on insurance based schemes
Before the introduction of the National Health Service (NHS), family doctors (General Practice) charged for their service. The majority of families that were Low-paid asked for a GP as a last choice, often they had to borrowing money from their families, neighbours or the pawnbroker to pay the bill. However more affluent workers paid into ‘Friendly Societies’ as insurance. In some parts of Brittan, workers joined together to pay a doctor with a weekly stoppage out of their wages. The trade unions also organised clubs like this were the worker could see a GP when they were sick the trades unions realised that keeping a healthy work force was more hands on tools. Some cottage hospitals were built with workers’ contributions, particularly in mining areas like South Wales.
However the NHS was to be financed almost 100% from central taxation. Bevan regarded this as a crucial part of the scheme that the rich should pay more than the poor for comparable benefits and People could be referred to any hospital, local or more distant also everyone was eligible for care, even people visiting the country or temporarily resident. Care was entirely free at the point of use. This proved to be a costly mistake as the government underestimated the demand on the NHS with most people it proved to be extremely popular as it quickly found that its resources were being used up from NHS earliest days it seemed to be short of money the annual sums that had been set aside for glasses and for treatment such as dental surgery were quickly used up. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks estimates of the cost of the NHS were soon exceeded and within three years some although prescription changes and dental charges were subsequently introduced a charges of one shilling (5p) and a flat rate of £1 for dental treatment. This was a small amount if you compare the price of a prescription in the United Kingdom today is £7.20 per item. The cost of NHS dental care most courses of treatment cost £16.50 or £45.60. The maximum charge for a complex course of treatment is £198. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million.
Over the years the NHS went through many rough periods over finances and in the 1970s things managed to go from bad to worse, Brittan was in the gip that can only described industrial unrest It was the decade of strikes, piles of rotting rubbish on the street and electricity shortages for thousands of people the 70s was a time when people were just trying to make ends meet in difficult economic conditions, when industrial action hit the NHS and Financial problems also hit the service in 1978 and 1979 as oil shortages in the ‘winter of discontent’ took hold. This was not help when the consultants went up in arms over the proposals to reduce the amount of private work they undertook.
The 1970s started the ongoing debate on the best way for the NHS to evolve. With this in mind GPs introduced the first charter to encouraging the growth of primary care in the UK match local health authority boundaries with the new boundaries created in local government. A new system of distributing the resources of the health service more evenly was also implemented in 1974, a few months later a Royal Commission was appointed to look into the problem.
The NHS was slowly changing its mind set looking at people as customers and not as patients and turning towards private investors to help fund and shape the NHS; however before the introduction the first wave of 57 NHS Trusts came into being in 1991and By 1995 all health care was provided by trusts. The majority of family doctors were given budgets to buy health care from NHS trusts and they could also buy health care from the private sector this scheme was called GP fund holding. Patients of GP fund holders were often able to obtain treatment more quickly than patients of non-fund holders. Becoming a NHS trusts this was the new future was to be a ‘provider’ in the internal market, health organisations, independent organisations with their own management, competing with each other.
Community care as we know it today came in the 1950s and 1960s; this was the result of political realism and progress in the understanding of mental health and the treatments now available this also includes social changes civil rights campaigns and a rise in the patients’ rights movement, moving away from the isolation of the mentally ill in old Victorian asylums towards their re-integration into the community.
The 1959 Mental Health Act encouraged the development of community care and abolished the distinction between psychiatric and other hospitals. This was seen as the biggest political change in mental healthcare in the history of the NHS, During the 1960s the populist continued to move against the big hospital institutions Psychiatrists questioned traditional treatments for mental illness, with the introduction of new psychotropic drugs also meant patients could be more easily treated outside of an institution.
Enoch, the former health minister was dubbed by some as the Father of Community Care; he argued that mental hospitals were effectively prisons, preventing the patients return to normal life. Powell also belief that community care would be cheaper than hospital care the new district general hospitals contributed to the reduction in the number of beds in mental hospitals from 150,000 in the mid-1950s to 80,000 by 1975.
The Mental Health Act 1983 set out the rights of people admitted to mental hospitals, the introduction of legislation would give the mentally ill more rights allowing them to appeal against committal.
In 1984 Sir Roy Griffiths led a government inquiry into community care, after the murder of social worker Isabel Schwarz she had been killed by her former client. In 1998 Sir Roy Griffiths report outlined the Community Care: Agenda for Action’ was the forerunner to the Community Care Act of 1990, major legislation which sets out the basis for community care as we know it today.
The government invested an extra £510m in mental health services in England, Frank Dobson the then Health Secretary said the extra £510m for NHS mental health services over the following 3 years would add to the £180m announced for social services care of the mentally ill. This would include a revision of the controversial care in the community policy. He also told the House of Commons that mental illness was not “an obscure, minority concern”, but affected one in six people at any one time.
The £700m will be broken down with at least £500 million being ear-marked within for targeted change in the way services are delivered, around £120 million will be spent on new and effective drug therapies and £70m will go towards training mental health nurses and psychiatrists, and other care and clinical staff.
The government’s drive to Modernising Mental Health Services strategy document included a new national service framework it laid out guild lines on how they can best treat people and it clearly spelt out the range of services needed for the mentally ill.
The new strategy included: More mental health beds, more supported housing and hostels, More training for health workers, Improved services for adolescents and young people Access for the mentally ill to the NHS Direct helpline Access to new mental health drugs More day centres for the mentally ill and more outreach teams and a 24-hour crisis teams.
In the last five years mental health services in England is going through an unprecedented change. A Government programme has been launched to improve on the quality of mental health care, and improve the mental well-being of people in England; the policy has implementation guides and good practice examples.
New Horizons: a shared vision for mental health is a comprehensive initiative that will be delivered by ten national Government departments.
New Horizons forms an alliance of, local communities and individuals and the voluntary sector and professionals, to work towards a society that values mental well-being as much as physical health and it outlines the benefits of unlocking the benefits of well-being in terms of physical health, educational attainment, employment and reduced crime and in turn reducing the burden of mental illness.