Module: Health and Social Policy
Session: Health and Social Policy: An Overview
[webplaced
22nd February 2001; updated 14th November 2001]
[author:
Ian Hodgson]
This session will:
·
define social and health policy
·
provide an overview of the historical context
·
examine various models of social administration/policy
·
analyse the salient features of the most recent dominant
frameworks, that of the ‘New Right’; and those of 'New Labour'
1. Definitions and Issues
Policy = ‘principles that govern action towards given
ends’ (Abel Smith. Titmuss) - in situations in which change can be effected
(eg. poverty, as opposed to the weather)
Policy = ‘a web of decisions and actions that allocate
values’ (Easton, 1953, cited in Ham, 1992) - [include Easton’s diagram of a
political system]
Social policy = a
positive instrument of change, though not always altruistic ! (policies of
Hitler)
Social policy (or a system of social welfare) is part of
the regulatory mechanism built into a ‘natural’ social system (Titmuss, 1977)
Social policy is (various sources) - not necessarily
always morally ‘good’ (note SA policies during apartheid); the desire to ensure
every member of the community certain minimum standards and opportunities;
concerned with the communal environment; an attempt to steer society along
channels it would not follow if left to itself; consists of social insurance
(ie.social security), public/national assistance, health and welfare services,
housing policy.
Social policy (or social administration) emerged from
politics of collectivism and state intervention to deal with social problems at
beginning of 20thC - essentially the Liberals, Fabians and Socialists.
Therefore, SP = actions that effect the ‘community’, and
encompasses:
·
housing policy
·
social class and health
·
(un)employment and health
·
social crisis - poverty, social deprivation
welfare provision education policy
QUESTION: What do you think the issues are at the moment
??
· community
care
· Black
(and subsequent) reports - inequalities in health
· what
are/who defines needs ?
· last 50
years - Beveridge Report to present day
· how is
‘justice’ to be distributed ? - to each according to need, worth, merit, work
??
·
KEY STATEMENT: SP is not blind, but tends to reflect the
dominant values of the society from which the policies originate - historically
policies have been racist and sexist
ALSO: economic expediency often becomes political
philosophy, and according to the approach, it divides or unites social and
economic man
Health policy is:
The development of general policy, and the provision of
health services, by the state.
Key issues (Ham, 1992):
q
who are the key interest groups, and what is their
relationship with the decision makers ?
q
there is often a gap between the intention of policy makers, and what happens in practice
q
what is the relationship between policy makers and service
providers ?
q
what are the purposes
served by health services ? (eg. what is the significance of the dominance of
medical staff ?)
2. Models of social policy:
QUESTION: What approaches to H+SP do you think there are ?
A - residual welfare model [also laissez-faire] -
two natural channels though which needs can be met - private marker and family -
social welfare intervenes only when these structures brake down, and then only to teach people how to do without it
Traceable back to Poor Law, and 20thC supporters include Hayek and Friedman
B - Industrial Achievement-Performance Model -
social need met on the basis of merit, work performance and producticvity
C - institutional redistributive model - social
welfare = major integrated institution in society, providing unversailistic
services outside of the market and based on individual needs
3. Historical context:
QUESTION: What interventions can you think of over the
last 100 years ?
1830s - 1880s - Early State Intervention
Driven mainly by laissez faire/liberal philosophy -
following in wake of industrial capitalism.
Thus, state intervened only to maintain ethos of the free
market - eg.
POOR LAW AMENDMENT ACT of 1834 (amending 1601 ‘Old’ Poor
Law’) - in which the emphasis was on motivating people to seek work, and avoid
the shame and embarrassment of asking for state aid. Key principles:
·
no person on benefit should be better of than lowest paid
worker
·
conditions of accepting relief would be so shaming as to
deter people for applying for it, and push them into labour market
·
settlement law made cost of relief the responsibility of the
parish in which the person settled (power of removal gave parish right to ship
them back to where they had come from - effected Irish most)
·
shift responsibility for maintenance of children of single
mothers to mother, away from father/parish
Poor law created notion of deserving and undeserving poor
- created stigma of workhouse being refuge of lazy and immoral people (eg. lone
parents)
Also, capitalism had separated home and work, making the woman subservient and inferior, and
existing to support (and be dependent upon) the main breadwinner
FACTORY ACT (1844) - a Good Thing because introduced
protection, but also reflected Victorian Morality - excluded women from certain
areas of work, and encouraged them to stay at home
CONTAGIOUS DISEASES ACT (1864 and 1886) - allowed forcible
incarceration of women suspected of being prostitutes
1880s to 1940s
Laissez faire approach shaken by: threats of manufacturing
from overseas (Japan, USA); fall in birth rate; lack of healthy pool of men to
fight Boer War; imperial threats from Germany and Ireland; new Unionism
(organisation of workers), manifesting in Dock Strike of 1889; general
awareness that free market capitalism was subject to booms and slumps, rather
than smooth progression giving rise to periods of unemployment threatening
political stability; rise of socialism (Marxism); suffrage - etc. etc.
Thus, Liberal govt
of early 20thC introduced a number of reforms, reflecting a change in social
policy, financed by a different form of taxation (regressive):
·
1908 - pensions
·
1911 - contributory insurance scheme (for unemployment
benefit), plus school meals and school inspectorate
1945 onwards
BEVERIDGE REPORT - 1942 - attack on 5 giants - want,
squalor, idleness, ignorance and disease
Keynesian notion of spending money to create growth
prevailed in economic policy
1950s - 1970s
Welfare consensus
1970s onwards - gradual shift towards model A above - catalysts
being:
·
reduction in economic growth;
·
growing cost of welfare state (both Heath and Callaghan looked
at ways of reducing spending)
·
questions being asked about effieciency of welfare state -
in 1970s 70% of public expenditure = on welfare state, but still poverty
widespread
1980s -
Growth of new right, and the Care in the Community initiative (deinstitutionalisation of
elderly, and handicapped) - one of results = more emphasis on the home (and lay
carers) in the support of the infirm
This is linked to philosophy of freedom, individual
responsibility and choice (Conservative Party Conf., 1983), and.......
Centralisation of spending powers, away from local
authorities
Key legislation = Social Security Act (1986) - this:
·
reduced earnings related element of unemployment benefit
·
disallowed benefit to young people who declined places on
training schemes
·
introduced income support system, taking into account
personal savings
·
changed pension system, allowing (from 1999 retirements)
people to opt out of SERPS (at their won risk) and take on private schemes
4. Different Perspectives of Welfare
QUESTION: Imagine a continuum - where would you place the
particular political parties ?
·
anti-collectivism - economic liberalism, free market,
minimize state role, policies of new right
·
non-socialist welfare collectivists - Liberals, Beveridge,
Keynes, SDP ! - state welfare provision necessary for national efficiency and
alleviation of worst deprivation, but can come from private/voluntary sectors
(mixed economy)
·
Fabian socialists - human centred; welfare state central
to transformation of society through redistribution of wealth
·
radical social administration - welfare state central to
socially planned society, which includes redistribution of wealth and resources
and pursuit of equality
·
Feminist and anti-racist critiques - welfare state
directly inhibits rights of certain social and minority groups
The New Right - an analysis
1. Political and Economic
freedom = the absence of coercion (Hayek, 1960)
Emphasis on social policy and welfare provision will be to
create a climate in which the supply side
is strong, with providers competing for the business of the purchasers.
Central government will limit itself to the making of general policy, and the laying down of general rules, for the government cannot
know the intricacies of individual merits and factors within a situation.
Weaknesses of current position of welfare provision:
·
individual initiatives are sapped
·
Freidman - expenditrues have increased markedly, with
‘better off’ being favoured; political expediency drives the welfare state, and
therefore voucher system would be of benefit, espceially to poor
Public tends to support the welfare state while opposing
state intervention in the economy
Thus:
·
privatisation will be encouraged
·
spending as a proportion of GDP will be reduced
·
there should be a return to real family values
·
there should be a reduction in taxation
Ideological factors: welfare cuts - likely to gain
approval if:
·
presented in the context of approval of non-intervenionist
state rather than attack on social provision
·
cuts more likely to be favoured if focussed on unfavoured
groups
·
community care more marketable if presented as rolling
back of state rather than imposition on middle aged women (bulk of lay carers)
Long term goals:
·
remove state monopoly on welfare provision
·
transform state from provider to regulator
·
facilitate state provision only for those who ‘need’ it
·
ensure changes introduced are unassailable
·
supply side must be expanded to include many
suppliers, and ownership must be to private provision
·
demand side must be expanded to include many buyers
New Labour - an analysis
New
Labour and
The NHS
White Paper
'The white paper marks a turning point for the NHS. It replaces the
internal market with integrated care'
Tony
Blair, December 1997
Integrated
care: health improvement programmes jointly agreed by all who are charged with
planning or providing health and social care
The Third Way: 'no return to the old
centralised command and control systems of the 1970s…..nor the continuation of the
divisive internal market system of the 1990s'
|
The Six Key Principles of the NHS White Paper |
|
1. renew the NHS as a truly 'national service' |
|
2. encouragement of 'local responsibility' - local staff
'shaping services' |
|
3. forging of 'partnership…..with local authorities' |
|
4. cutting bureaucracy and aiming for 'efficiency' |
|
5. 'shift focus onto quality of care' |
|
6. rebuild 'public confidence in NHS' |
[source: Department
of Health, 1997]
Key principles
of the NHS White Paper - do they reflect a change in social and health policy
New Labour and the
Welfare State
According to Labour, the welfare state is too expensive -
social security budget is £95bn.
Aims of social security are: help the poor (means tested);
provide social insurance for all (not means tested.
Much of the current debate centers around this dichotomy.
Major reforms that are proposed:
·
continue
to benefit from cuts introduce by previous government (my comment !)
·
pensions - introduction of compulsory second pension
scheme for those in work
·
cutting
disability benefits and attendance allowance
·
'Welfare
to work' - including pro-active job seeking service
·
means
tested benefits (eg. maternity)
·
address
the £5bn lost from fraudulent claims (source: National Audit Office)
Overall aim of reform is to 'help the people who are in
genuine need'; and 'to do more for those who can't work or are disabled'
(Blair, 1998).
How different is this from the policies adopted by the 'New Right' ?
Since 1997….
Social and health policies are not ‘blind’. They tend to reflect the dominant values of the society from which they policies originate. So…
References
Political
Flynn, N. (1989) - The ‘New Right’ and social policy. Policy
and Politics, 17 (2), pp 97-109
Friedman, M. & Friedman, R. (1980) - Free to Choose.
Pelican, London
Hayek, F. (1960) - The Constitution of Liberty.
Routledge and Kegan Paul, London
Hindess, B. (1987) - Freedom, Equality and the Market:
Arguments on Social Policy. Tavistock, London
Klein, R. (1995) – The Politics of the National Health Service.
Longman, London
Oalkey, A. & Williams, S. (1994) – The Politics of
the Welfare State. UCL Press
If you
have internet access, information about political parties can be found at:
www.ukplus.co.uk/
Historical
Abel-Smith, B. (1992) - The benefits of Beveridge. New
Statesman & Society, 27.11.92
General
Alcock, P. (1996) - Social Policy in Britain: Themes
and Issues. Macmillan, London
Glennerster, H. (1995) – The Politics of the National
Health Service. Blackwell, Oxford
Ham, C. (1992) - Health Policy in Britain: The Politics
and Organisation of the National Health Service. Macmillan, London
Hill, M. (1993) – Understanding Social Policy.
Blackwell, Oxford
Titmuss, R. (1977) - Social Policy: An Introduction.
Allen and Unwin, London
Williams, F. (1989) - Social Policy: A Critical
Introduction. Polity, London
If you
have internet access, the most recent NHS White Paper can be found at:
www.open.gov.uk/doh/newnhs.htm
Further,
general information can be found at:
www.brad.ac.uk/staff/ijhodgson/healthsocial_policy.htm