HEALTH AND SOCIAL POLICY

Health and Social Policy

Health and Social Policy

Introduction

The welfare state is elusive. It has repeatedly defied political attempts to contain it. Only once since 1945 has welfare expenditure fallen in real terms - under Labour in 1977/78. Under the Conservatives since 1979 it has risen relentlessly, most markedly in election years. It has also defied effective academic analysis. Indeed, in their common critique of centralised bureaucracy and the need to empower the consumers of welfare, critics on both the political right and left have appeared to adopt strikingly similar positions (Bradley, 2003, 22).

Origins of the Welfare State and its Rationale in the United Kingdom

In Britain, the beginning of the modern welfare state was in 1911 when David Lloyd George and his Liberal Party enacted the National Insurance Act 1911 setting up a national insurance contribution for unemployment and health benefits from work. In 1942, the Social Insurance and Allied Services was created by Sir William Beveridge in order to aid those who were in need of help, or in poverty. Beveridge worked as a volunteer for the poor, and set up national insurance. He stated that 'All people of working age should pay a weekly national insurance contribution. In return, benefits would be paid to people who were sick, unemployed, retired or widowed (Bradley, 2003, 22).'

The basic assumptions of the report were that the National Health Service would provide free health care to all citizens. The Universal Child Benefit was a scheme to give benefits to parents, encouraging people to have children by enabling them to feed and support a family. One theme of the report was the relative cheapness of universal benefits. Beveridge quoted miner's pension schemes as some of the most efficient available, and argued that a state scheme would be cheaper to run than individual friendly societies and private insurance schemes, as well as being cheaper than means-tested government-run schemes for the poor.

Part of the problem is one of definition. What precisely is a welfare state? After a lifetime of study, Richard Titmuss concluded that it was an "indefinable abstraction" but, given Beveridge's identification of "five giants on the road to reconstruction", it would seem that any definition has to embrace the relevant policy areas of social security, health, employment, housing and education. Many, however, would baulk at the inclusion of the last three because, through the full utilisation of a well-trained and mobile workforce, they actively contribute to wealth creation. This does not conform to the definition of "welfare", at least in its American usage, which concentrates more on the relief of need.

Others would champion a wider definition including the personal social services (unified in 1970), fiscal and occupational welfare. Changes in taxation, as the 1980s has shown, can have as great an impact on individual welfare as any conventional welfare service. Subsidised occupational welfare - "private enterprise in the public interest" - was also a prime objective of postwar Conservatism under R. A. Butler. Yet others would expand the definition still further to ...