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