This essay will be looking at health and social care within the British welfare state. To illustrate the broad structure within this topic, the differing roles of sectors and agencies and professions will be described and also the difference between health and social care to aid the discussion. The health and social care relationship and its distinction will then be analysed using the origins and historical background in relation to its social and ideological context.
The effect of the similarities and differences and how they affect the individual as a patient, service user or professional will also reviewed and the effectiveness of these services working together. To conclude, the four UK nations’ structures will then be compared and contrasted with two outlined in relation to how the professionals, service users and patients are affected.
The welfare state
The term welfare state is said to also mean the same as ‘state welfare’ and the state does not act alone but as a combination of assemblies working together. The public sector is used by the state with the ability to dictate an organisation to guarantee consistent or the lowest expected standards, for social control when protecting (child abuse), punishing (prisoners) or increasing freedom (from compulsory education).
The state also puts into consideration the most effective way around costs for example with the NH systems they are confirmed to be cheaper than other systems i.e. liberal. Last but not least the state is a protection net when other sectors fail to support or supply. This sector is filled with professionals such as nurses, doctors, teachers to supply services to every citizen who is entitled to the service and who is in need of the services.
The state also provides the funds to aid welfare in these sectors. The private sector links into welfare through occupational welfare – supplying services to employees, delegated welfare activity- this is where the private sector acts as an assistant to the government e.g. collecting taxes, participates in policy making and government processes and corporate social responsibility – this is where the agencies are trying to improve the welfare in society for others.
The voluntary sector on the other hand is very diverse which include direct service giving, running voluntary organisations. Over the years health and social care has endured a number of reforms within the UK and under the welfare state especially the Poor laws (1601 and 1834), the Beveridge report 1945 which later on lead to reforms in healthcare and the creation of the National Health Service (NHS).
There are five main sectors within welfare and they are public sector which is supplied by the state, private sector supplied for profit by marketing firms or organisations or even individuals, voluntary which aid is provided not for profit, informal which is supplied by friends and family maybe even neighbours and mutual aid which is provided by unity and alliances. Discussions about the welfare state are mainly based on social services which are provided for the people by the institutions or agencies of the state. Personal social services take care of people who fall out of the health aids. This job mainly falls down to the social workers even though their work if defined but what they do and who their client is.
Their work is sometimes called ‘casework’ or ‘direct’ work which involved: being a logical thinker (problem solver), psycho-social therapy, carrying out the agency’s functional tasks which build on initiative, changing behaviour and crisis intervention. Their positions as social workers counts on how the worker understands the situations or issue presented to him/her. The Barclay report based in this field presented a new belief in ‘indirect’ social work which contains supervising staff, community development, volunteers, training etc.
Health and social Care
In terms of health the NHS is seen by many as the core of the welfare state because people have rights to free healthcare and there is no right to healthcare on demand. “Primary” or first level care is provided by your General Practitioner [GP] who may also have a health visitor attached to the surgery and a community nurse. Secondary Care is provided in the hospital where a patient would be referred by their GP.
Doctors including casualty doctors, ward nurses, surgeons, Occupational therapists, paediatricians [child specialists] physiotherapists, radiographers work in the hospital. Other NHS staff includes consultant psychiatrists who may work either in a hospital or a community [local] team. There may also be psychologists and community psychiatric nurses in this team also.
Whereas social care services are the responsibility of your local council and paid for through council tax, sometimes the council buys services from private companies, e.g. home care or care homes. Social services include day centres, care in home, adult placements and Care Homes for adults. For children: Family Centres, Support in the home, Foster Homes, Children’s Homes etc.
Health and social care are organised and financed separately it is vital that workers in health and social care work together because patients and service users expect high standards. Access to health services depend on whether you are registered with a GP, you have the right to be medically examined except out of practice hours which are redirected to NHS 24 a telephone service. The NHS serves to protect all. However homeless people have the most difficulty accessing these services because they don’t have a permanent address so therefore they cannot register.
This shows that the NHS is not all comprehensive or inclusive and only delivers according to its priorities. To begin with the main idea surrounding the NHS is that no one should be averted from pursuing these services because they don’t have resources. First charges were introduced by Labour in 1950 then later on increased by Conservative after 1979 and the 1988 Act abolished free eye tests.
Three departments were solely accountable for personal social services: in charge of public health and other aspects was the departments of health, accounting for residential care and help to elderly and the disabled was the departments of welfare and last but not least was the children’s departments, accountable for child care. Social work and social services departments in Scotland, England and Wales were all united in the 1960’s and this was the driving force behind social as a general profession. Even though a large number of the social services leaned heavily towards residential care, departments such as SSD were mainly focused on child care.
However, this was slightly toppled by the community care policies introduced in 1990s. This was due to the Griffiths report in 1988 which gravitated towards merging children’s services with education departments to be now planned jointly. After the creation of SSD, the ambition was toward combining their activities jointly with that of the health services’. The Griffiths Report on care in the community 1988 said otherwise.
This report stated the belief that instead of joint agencies working together, there should be one service that provides all this with a clear definition and in relation to care in the community this would fall on the SSD/ social work departments in Scotland and this would come all under one budget that they control. Their role would then be to purchase care from various providers and to be able to do this they need to be building networks with the providers and making deals with them. Although there was news that this would be implemented, the community care reform didn’t manage to thrive because there was only one buyer which was the SSD, Social Work and Adult Services.
Social Policy and the welfare state.
Britain’s social policy was ruled by the Poor Laws starting with the Elizabethan Poor Law of 1601. The poor law was established and accounted for a permanent poor rate, the creation of ‘overseers of relief’ and the provision for setting the poor on work. Unions of parishes played their part as the unit for management however no devices were set in place to enforce the poor law into place so as a result it became irregular and conflicting in some areas. The population explosion and the growth of towns which were a result of the industrial revolution led to a rise in unemployment and this also lead to increased poor rates.
This lead to the amendment of the Poor law commission 1834 which gave priority to two main standards which were: “less eligibility: the position of the pauper must be 'less eligible' than that of the labourer” and secondly, workhouses ceases to give anymore relief. People weren’t all that fond of the laws they were strongly disliked to the point where the social services development within the 20th century tried to avoid any relation to them.
The Beveridge Report 1942 had ‘Five giants’ to slay - want, squalor, disease, ignorance and idleness and it was based on a single comprehensive programme of contribution-based benefits , not means tested [Tax-funded means-tested benefits to those whose needs were still not met by insurance scheme (National Assistance)]. The report also suggested an organisation for National insurance which is established around 3 fundamental points: family grant or allowance, the NHS and full employment. This report planned to cover people from the ‘cradle to the grave. B
oth parties saw this as a huge opportunity to use the report as a propaganda weapon, the coalition govt. decided to commit to full employment through Keynesian policies, no expenses on education and available to all and the new emergence of family grants. Elected in 1945 the Labour government introduced three main ideas: National Insurance act 1946 which established Beveridge’s blueprint on social security and allowed for the first time a comprehensive programme of benefits to help with unemployment, the NHS Act 1946 allowed for free health services, universally available to all and National Assistance Act 1948 which put an end to Poor Law for good.
After 1948 the welfare state was based on these main ideas: social security, health, housing, education and welfare and social services. Having established the welfare state wasn’t retaliating to poverty because that is why the previous Poor Law existed to begin with. Its main ambition was to support social services equally as other public services such as libraries for example to show a well-established model of welfare.
The welfare state having been introduced there was now a broad general agreement on the role of the state in meeting health and social care needs. Strategies for health and social care had been a large part of government social policy since the war but now the central issue was how those needs would be met. Sociologist TH Marshall [Citizenship and Social Class (1950)] talked about the rights of people as citizens to “a modicum of welfare”.