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The Welfare State
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Before Beveridge
Before Beveridge and after Beveridge
(1942) Wrong to take Beveridge's claims of
"revolutionary change" at face value. Britain
already had a system of insurance against illness
and unemployment, although it was imperfect and
incomplete, and left some sections of the
population relatively unprotected. The "New Poor
Law" of 1834 restricted poor relief to people who
were absolutely unable to fend for themselves
the very sick and the very old. Anyone else who
fell on seriously hard times had to go to the
"workhouse". Workhouses were tough, unpleasant
places were the very poor had to work hard to
earn their (often sub-standard) keep. People
hated them.
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Before Beveridge
The Liberal government of the early 20th century
introduced a system of National Insurance in
1911. Workers contributed to a system of
national insurance to protect tham against
sickness and unemployment. After the First World
War, in an attempt to provide "homes fit for
heroes", the government undertook to build
"council houses" for working-class families
living on low incomes (1919).
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Beveridge
In 1940 Winston Churchill became Prime Minister
of a coalition government. Labour insisted that a
report should be produced into "Social Insurance
and Allied Services". Sir William Beveridge was
asked to produce the report. It was published in
December 1942. Beveridge had ensured that it was
given great publicity. It sold in large numbers.
It is best known for its introduction, and
especially for Beveridge's plea that there should
be a comprehensive attempt to deal with a wide
range of social problems (the "five giants").
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Beveridge
These "five giants" were Want Disease Ignorance
Squalor Idleness
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Beveridge
Want poverty Disease (health care) Ignorance
(education) Squalor poor housing Idleness
unemployment
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(No Transcript)
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Beveridge
Lord Beveridge, photograph by Yousuf
Karsh. Camera Press, "Beveridge, William Henry
Beveridge, 1st Baron." Encyclopædia Britannica.
2005. www.britannica.com
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After Beveridge
Many in the Labour party called for "Beveridge
now!" The Conservatives showed less enthusiasm,
and although Churchill said that he found welfare
to be a praiseworthy objective, he said he would
make no promises. There would be other priorities
after the war. This was undoubtedly one of the
reasons he lost the 1945 general election.
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After Beveridge
Family Allowances were introduced before the end
of the war, in 1945. The Butler Education Act,
1944, introduced free secondary education for all
(up to the age of 15) (see next lecture). The
rest of the legislation underlying the Welfare
State was introduced during the 1945-1951 Labour
government under Clement Attlee National
Insurance Act 1946 (social security in return for
contributions) National Health Service Act 1946
free medical care "from the cradle to the grave"
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After Beveridge
National Health Service General Practitioners
(GPs) were paid a "capitation fee" for providing
health care for the people under their
responsibility (their "panel"). Health care was
"free at the point of contact". Patients did not
pay for appointments with a doctor or a dentist,
for drugs, for hospital care, for glasses ...
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After Beveridge
National Assistance Act 1948 "safety net"
protection for people who were not covered by
National Insurance. In 1950 Clement Attlee was
able to claim that "the foundation of the Welfare
State have been very well and truly laid" (quoted
Les clés ... p. 179)
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Welfare State
The Welfare State soon ran into financial
difficulties, and charges were introduced in the
early 1950s for prescriptions and for spectacles
and dentures ... It had been assumed that
spending on health care would gradually fall, as
the "backlog" of poor health was gradually dealt
with. What happened was quite the opposite.
Better technology, increased expectations, longer
life expectancy ... all conspired to drive health
care spending up.
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Welfare State
The Conservatives, whatever misgivings or
ideological distaste for the National Health
Service there might have been in some places, did
not radically alter the system, until Margaret
Thatcher.
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Welfare State
During the 1950s efforts were made to make the
system work. New hospitals had to be built and so
on. Full--or practically full--employment helped
... In the 1960s, however, sociologists claimed
that poverty had not been eradicated. Various
reforms addressed this persistent problem.
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Welfare State
Under Margaret Thatcher determined efforts were
made to combat "scrounging" and encourage
"responsibility". Many benefits were cut. More
visible homeless. More recently, the
introduction under Tony Blair's Labour government
of a minimum wage has responded to a
long-standing demand by the trade unions and
others, though they said it was set too low.
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Welfare State
NHS Housing
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Welfare State - NHS
NHS Under the Thatcher governments a new
philosophy was introduced contracting-out of
services (cleaning, catering, ...) and internal
market GPs given funds to buy services for their
patients
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Welfare State - NHS www.nhs.uk
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Welfare State - NHS www.nhs.uk
Primary Care This is the care provided by people
you normally see when you first have a health
problem. It might be a visit to a doctor or
dentist, an optician for an eye test, or just a
trip to a pharmacist to buy cough mixture. NHS
Walk-in Centres, and the phone line NHS Direct,
are also part of primary care. All the people
offering primary care are now managed by new
local health organisations called Primary Care
Trusts (PCTs).
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Welfare State - NHS www.nhs.uk
Primary Care Trusts Primary Care Trusts (PCTs)
are local health organisations responsible for
managing health services in your local area. They
work with local authorities and other agencies
that provide health and social care locally to
make sure the community's needs are being
met. PCTs are now at the centre of the NHS and
will get 75 of the NHS budget. As they are local
organisations, they are in the best position to
understand the needs of their community, so they
can make sure that the organisations providing
health and social care services are working
effectively.
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Welfare State - NHS www.nhs.uk
Primary Care Trusts For example, PCTs must make
sure there are enough services for people in
their area and that they are accessible to
patients. They must also make sure that all other
health services are provided, including
hospitals, dentists, opticians, mental health
services, NHS Walk-In Centres, NHS Direct,
patient transport (including accident and
emergency), population screening, pharmacies and
opticians. They are also responsible for getting
health and social care systems working together
to the benefit of patients.
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Welfare State - NHS www.nhs.uk
Doctors / GPs GP General Practitioner Doctors
look after the health of people in their local
community and deal with a whole range of health
problems. They also give health education and
advice on things like smoking and diet, run
clinics, give vaccinations and carry out simple
surgical operations. Doctors usually work with a
team including nurses, health visitors and
midwives, as well as a range of other health
professionals such as physiotherapists and
occupational therapists. If a Doctor cannot deal
with your problem themselves, theyll usually
refer you to a hospital for tests, treatment or
to see a consultant with specialised
knowledge. Every UK citizen has a right to be
registered with a local Doctor and visits to the
surgery are free.
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Welfare State - NHS www.nhs.uk
Secondary Care If a health problem cannot be
sorted out through primary care, or there is an
emergency, the next stop is hospital. If you need
hospital treatment, a GP will normally arrange it
for you. NHS hospitals provide acute and
specialist services, treating conditions which
normally cannot be dealt with by primary care
specialists. Primary Care Trusts are responsible
for planning secondary care. They look at the
health needs of the local community and develop
plans to improve health and set priorities
locally. They then decide which secondary care
services to commission to meet peoples needs.
Therefore they work closely with the providers of
the secondary care services that they commission
to agree about delivering those services.
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Welfare State - NHS www.nhs.uk
NHS Trusts Hospitals are managed by NHS Trusts
(also known as Acute Trusts), which make sure
that hospitals provide high quality health care,
and that they spend their money efficiently. They
also decide on a strategy for how the hospital
will develop, so that services improve. Trusts
employ most of the NHS workforce, including
nurses, doctors, dentists, pharmacists, midwives
and health visitors as well as people doing jobs
related to medicine - physiotherapists,
radiographers, podiatrists, speech and language
therapists, counsellors, occupational therapists
and psychologists. There are many other
non-medical staff including receptionists,
porters, cleaners, IT specialists, managers,
engineers, caterers and domestic and security
staff.
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Welfare State - NHS www.nhs.uk
NHS Trusts Some Trusts are regional or national
centres for more specialised care. Others are
attached to universities and help to train health
professionals. Trusts can also provide services
in the community, for example through health
centres, clinics or in peoples homes. Except in
the case of emergencies, hospital treatment is
arranged through your GP. This is called a
referral. Appointments and treatment at NHS
hospitals are free.
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Welfare State - NHS www.nhs.uk
Foundation Trusts Foundation Trusts are a new
type of NHS hospital run by local managers, staff
and members of the public which are tailored to
the needs of the local population. Foundation
Trusts have been given much more financial and
operational freedom than other NHS Trusts and
have come to represent the Government's
commitment to de-centralising the control of
public services. These Trusts remain within the
NHS and its performance inspection system. The
first 31 NHS Foundation Trusts have been
authorised by the Independent Regulator and were
established on 1 April and 1 July 2004, and 1
April 2005
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Welfare State - NHS www.nhs.uk
NHS History 1988 - 1997 Internal market The NHS
experienced the most significant cultural shift
since its inception with the introduction of the
so-called internal market, outlined in the 1989
White Paper, Working for Patients, and which
passed into law as the NHS and Community Care Act
1990. The internal market was the Conservative
Government's attempt to address problems, such as
growing waiting lists, which had arisen in the
1980s as a result of NHS resources being
constrained while demand rose inexorably.
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Welfare State - NHS www.nhs.uk
NHS History 1988 - 1997 Before the 1990 Act a
monolithic bureaucracy ran all aspects of the
NHS. After the establishment of the internal
market, 'purchasers' (health authorities and some
family doctors) were given budgets to buy health
care from 'providers' (acute hospitals,
organisations providing care for the mentally
ill, people with learning disabilities and the
elderly, and ambulance services). To become a
'provider' in the internal market, health
organisations became NHS trusts, independent
organisations with their own managements,
competing with each other.
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Welfare State - NHS www.nhs.uk
NHS History 1988 - 1997 NHS trusts The first
wave of 57 NHS Trusts came into being in 1991. By
1995, all health care was provided by NHS trusts.
Over the same period, many family doctors were
also given their own budgets with which to buy
health care from NHS trusts in a scheme called GP
fund holding. Not all GPs joined this scheme and
their budgets were still controlled by health
authorities ...
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Welfare State - NHS www.nhs.uk
NHS History 1988 - 1997 GP fund
holders Patients of GP fund holders were often
able to obtain treatment more quickly than
patients of non-fund holders. This led to
accusations of the NHS operating a two tier
system, contrary to the founding principles of
the NHS of fair and equal access for all to
health care.
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Welfare State - NHS www.nhs.uk
NHS History 1988 - 1997 The New NHS Modern,
Dependable Observers credit the internal market
with improving cost consciousness in the NHS, but
at a price that the competition it encouraged
between 'providers' saw unnecessary duplication
of services. The election of a new Government in
May 1997 brought a new approach to the NHS.
Pledging itself to abolition of the internal
market, the new Government set out an approach
which aimed to build on what had worked
previously, but discarding what had failed.
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Welfare State - NHS www.nhs.uk
NHS History 1988 - 1997 A new white paper issued
by the Department of Health, "The New NHS.
Modern. Dependable.", put forward a "third way"
of running the service - based on partnership and
driven by performance. The paper set out an
approach which promised to "go with the grain" of
efforts by NHS staff to overcome obstacles within
the internal market, building on the moves which
had already taken place in the NHS to move away
from outright competition to a more collaborative
approach.
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Welfare State - NHS www.nhs.uk
NHS History 1998 to the present Since 1998 there
has been a huge series of initiatives, financial
and organisational changes, and alterations in
policy. ... The NHS Plan - which was
published in July 2000 - is a radical action plan
for the next 10 years setting out measures to put
patients and people at the heart of the health
service and promising a 6.3 per cent increase in
funding over five years to 2004. The NHS Plan
promises More power and information for
patients More hospitals and beds More
doctors and nurses Much shorter waiting
times for hospital and doctor appointments.
Cleaner wards, better food and facilities in
hospitals Improved care for older people
Tougher standards for NHS organisations and
better rewards for the best
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Welfare State - NHS www.nhs.uk
NHS History 1998 to the present ... Shifting
the Balance of Power Shifting the Balance of
Power was launched in April 2001. It launched the
NHS Modernisation Agency as the lead organisation
in reforming the way the NHS works. The aim was
to design a service that puts both patients and
staff at the heart of the NHS... Shifting the
Balance gave greater authority and decision
making power to patients and frontline staff. The
main feature of the change has been to give
locally based primary care trusts the role of
running the NHS and improving health in their
areas.
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Welfare State - NHS www.nhs.uk
NHS History 1998 to the present Creation of 28
Strategic Health Authorities Created in April
2002, covering an average population of 1.5
million, the main functions of the new Health
Authorities include supporting Primary Care
Trusts and NHS Trusts in delivering the NHS Plan
in their area and building capacity and
supporting performance improvement across all
their local health agencies. In October 2002 the
28 Health Authorities received their 'Strategic
Health Authority' status. All local NHS
organisations became part of a single structure
and held to account through their respective
Strategic Health Authority.
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Welfare State - NHS
NHS Prescription charges Charge per prescribed
item 6.50 ( approx 10 euros) For items
dispensed in combination (duo) packs, there is a
prescription charge for each different drug in
the pack. Prescription prepayment certificates
(PPC) Application received on or after 1 April
2005 4 months 33.90 12 months
93.20
http//www.dh.gov.uk/
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Welfare State - NHS
Help with NHS charges Entitlement to help with
health costs (NHS prescription and dental
charges, optical and hospital travel costs) is
based on the principle that those who can afford
to contribute should do so, while those who are
likely to have difficulty in paying should be
protected. Who can get help People can get help
on age or medical grounds or by being in receipt
of one of the exempting benefits or tax credits.
People who have to pay NHS charges may be able to
get help under the NHS Low Income Scheme. No
help is available if a person has capital in
excess of the limit 8,000 (12,000 if you and /
or your partner are aged 60 or more or 20,000
for people who live permanently in a residential
care home or nursing home). not including value
of patient's home
http//www.dh.gov.uk/
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Welfare State - NHS
Help with NHS charges Help can be given for
paying health costs for NHS
prescriptions NHS dental treatment
NHS wigs and fabric supports Sight tests,
glasses and contact lenses Travel for NHS
treatment under the care of a consultant You are
already entitled to full help with health costs
if you or your partner are getting Income
Support Pension Credit Guarantee Credit
Income-based Jobseekers Allowance
http//www.dh.gov.uk/