Effects Of Government Ideology And Policy
On
Health And Social Care In Britain From 1598

When considering government policy in the health and social care area it is important to understand the ideological belief which that policy is grounded on and how it can disadvantage certain groups within society while benefiting others.
The founding principles of the welfare state in Britain are widely agreed to have their beginnings with the poor law of 1598.
Poor law was the one state system intended to ‘relieve’ poverty whither it was caused by illness, old age or unemployment. The poor law offered two kinds of ‘relief’- ‘outdoor’ and ‘indoor’. Outdoor relief was provided to the poor who were considered ‘the deserving poor’ those who were old, poor and disabled. The undeserving poor for example unmarried mothers and those deemed immoral and unworthy entered the workhouse and were obliged to earn there ‘relief’. The Open University (1987) Social policy, and social welfare (D211) Course Materials, Open University press.5 page handout on social policy, circulated October 2006 for module on “The policy context”.
This of course led to the poor and disadvantaged of society being exploited and abused by those controlling industry and commerce. Those dependent on indoor relief were still in such states of poverty that they were forced to turn to crime and prostitute and further acts of immorality as considered by there so called betters/ superiors within the middleclass and hierarchy and landed gentry.
Many good examples of life at that time are depicted in the stories of Charles Dickens (1812-1851) such as Oliver Twist (1837-1939).
In 1834 the poor law was reformed. The existing poor law was administered by local parisher according to Alcot, Payne and Sullivan (2000 p12)
.There was diversity in the availability and generosity of the parish relief and fear that the Poor Law of the proceeding 250 years was no longer meeting the demands of 19th century Britain. Alcock, c. Payne, s .and Sullavan, m. (2000) Introducing Social Policy .London: Prentice Hall.
The 1834 Amendment act removed responsibility from the parish to elected boards of guardians who would administer relief in ‘unions’ supervised at a central level by the Poor Law Board.
In theory the act offered help to those in poverty which was regarded not to be there own fault and whose behaviour was considered respectable (Fraser, 1976, Thane, 1996)
(“Victorian poor law illustrates that many principles upon which state intervention in individual live was predicted remains today. Distinctions between the deserving and undeserving, the discouragement of dependence and the largety of help to the most needy are all stuff of the welfare reform debate initiated by successive governments in the 1980’a and 1990’s.”) Alcock, Pane and Sullivan (2000) Introducing social policy.London: PrenticeHall.
After the reform of the poor law in 1834 it wasn’t until1848 that the public health act came about. This act brought about provisions to set up local boards for health and the appointment of Medical officers of health.
There were several acts that followed bringing about important changes within the welfare system in Britain whose roots were firmly planted in conservative ideology.
Conservative ideology had its roots firmly grounded in maintaining the status quo which favoured landed gentry and aristocracy. Conservative ideology was the basis of the patriarchy and roles very much gendered with men deemed superior to women. Pro royalty, pro Church of England and pro charity they believe in strong government and were anti-change deeming that members of the higherarchy were born to rule.
In 1906 the liberals ended 20 years of conservative rule in a landslide victory (“The emergence of a strong labour element in the house of commons has been generally welcomed as the most significant outcome of the present election it lifts the occasion out of the ordinary groove of domestic politics and will have a far wider influence than any more turnover of the party voters”) (The times 30th January 1906)
In many ways the labour presence in the house acted as a social conscience for the liberal majority and prompted the first stirrings of welfarism. Alcock, c, Pane, s and Sullivan, M. (2000 p27) introducing social policy. London prentice hall.
The liberal party increased state intervention in the early 20th century with its ‘social liberalism’ philosophy. Social changes in the 18th and 19th centuries and the development of the industrialisation brought the growth of the urban society which in affect had a major effect on the physical and social conditions in which people lived. Walsh, M. Stephens, P. (2000) social policy and welfare. Cheltenam.Stanley Thornes.
The industrial revelation in Britain and urbanisation had a profound effect on the British social structure and class system.
In 1908 old age pensions were introduced and paid as a right from January 1909 and it hoped this would help elevate stigmas associated with the poor law, one of the most important structural principals of the British welfare state which still remains, was the introduction of social insurance proposed by Lloyd-George which was contributed to by employee, employer and government. These contributions would insure workers against ‘accident of life’ like ill health or death of the breadwinner which were major causes of poverty and destitution. This was extended during and after World War 1 and is recognised as farming the cornerstone of Beveridge’s proposal 30 years later. Liberal Ideology was based on the ideas of freedom, individualism and democracy. The ideology of the liberals suggested that all men were born equal and should be responsible for there own choices. However in reality in the 18th, 19th and early 20th century choice was a privilege of the upper classes denied to the poorer of society by social circumstances and standing. Much like conservatism liberal ideology favoured the higherarchy.
Liberal ideology was anti welfare state and follows the idea of laissez fare (free market) which encouraged businesses to compete freely and free of government interference. In its favour from 1908 until the 1930’s the liberal government did play its part in challenging the diversities and inequalities between social classes. The children’s act of 1908 gave protection to the children of all social classes by offering some protection against exploitation, often reflected in the stories of that time by Charles Dickens a good example being “The Water babies’. Dickens, c. (1838)
Liberal ideology was challenged during the early 20th century by the new ideology of the socialism which moved from individualist to collectivist ideas regarding welfare provision and felt that the government should create adequate conditions and opportunities for all to live healthy unfulfilling lives. Liberalism was challenged. ‘Emerging socialist ideas gradually challenged liberal welfareism and led to a demand for greater state intervention in the welfare provision’ Walsh, Stephens and Moore (2000) p44
Arguably the most influential political ideologies on the beginning of the welfare state in Britain as it is today are those attributed to the ideas of Fabianism. Fabians led by Sidney and Beatrice Webb, believed that socialism in Britain was compatible with institutions of the state and should be brought through parliamentary routes. They felt that goverment should promote the collective good umpiring between the demands of different interests, giving birth to ‘social administration’ which laid the foundations of today’s ‘social policy’
Fabians believed in the gradual social reform (‘inherent in the notion in gradual social change was the concept of the ethical socialism apparent in the writing theorist such as Tawney and Marshall. Within their writings was a notion of equality which emphasised self-esteem and dignity’) Alcock.Payne and Sullivan (2000, p30). These ideas area clearly reflected by Tony Blair’s strategies for the new right ideology and social reform policy of today’s government.
Sir William Beveridge (1879-1963) is regarded as the architect of the welfare state in Britain commissioned by Churchill in 1941 to investigate welfare schemes and improve them.
His ideas and principles led to the development of the National Health Service and national social security benefit system. Expanding the states role in the social policy making welfare provision.
The beveridge report of 1942 tackled five areas often referred to as the ‘five giant evils’ of the British society Want(poverty),Disease(ill-health)ignorance(lack of education),squalor(poor housing) and Idleness(unemployment) Walsh, Stephens and Moore (200 p45) social policy and welfare Cheltenham, Stanley, Thornes.
In 1945 the conservative led coalition was replaced by a labour government who took on the challenge of setting up a ‘welfare state’ that would tackle bevridges five giants with a view to creating an equal society putting social policy at the top of both the public and political agenda.
In 1946 the National Health Service act was established and the NHS came into being in 1948.
The three main principles of the NHS were.
1. That the service would be free at the point of delivery.
2. Comprehensive in the term of covering all people in all areas
3. Access to the service would be on the basis of ‘real’-that is clinical-need, rather then the ability to pay, chance or other social criteria.
This adhered to the labour governments ideological principles which believed in ‘democratic socialism and which also felt that there was a strong moral case. Walsh, Stephens and Moore (2000 p47)
Between 1948 and 1970 great headway was made within the health and social care services. However it is wildly recognised that in the late 1960s adverse economic conditions brought questions about the assumptions on which the ‘welfare state’ was based. It had been believed that full employment could sustain public funding of services by collecting money through income tax to pay for the services, conservative and labour governments in post war years had ‘tax-and spend’ polices to fund welfare services. However low income growth in the 1970s brought about a high public spending on welfare that could not be substained.With this came the development of the New Right Movement and new ideas challenged long held beliefs regarding how and why social services should be provided.
Walsh, Stephen and Moore (2000 p,50).
By 1975 the new right was led by Margaret Thatcher who led the conservative party to victory in the 1979 general election and so Britain saw the birth of Thatcherism.
Under the leadership of Margaret Thatcher the conservative party won three conservative general elections 1979, 1983 and 1987. Margaret Thatcher was a central figure in British politics and held office as a leader of the conservatives for almost twelve years, longer than any prime minister this century which in itself, rightly or wrongly earns her, her place in British political history.
The term Thatcherism refers to a particular style of leadership and a distinctive set of ideas and policies.
It is argued that it is an era of fundamental changes, whilst others regard it as time when old ideas were dressed in different clothes
There is evidence that supports the argument of a return to former conservative ideology during the thatcherite era, for example Thatcherism was based on a mixture of liberal and authoritarian new right ideas, which was seen to favour the better off and those in the middle classes. Many argued that Thatcherism was a return to the conservative ideology of the Dickensian era, while others feared it was a step towards the totalitarian state as depicted in ‘1984’ Orwell, G.(1949) .
The Thatcher government of the 1980s strategy was to limit a welfare state shifting responsible for welfare to personal, private and voluntary providers, reflecting liberal ideology of previous times which encourage lassiez faire, (allowing business to operate free of government interference.
Thatcher encouraged privatisation which she believed would bring three benefits,
1. It would raise government which would help stem government inflation.
2. Improve the efficiency of nationalised industry who would loose their monopoly status
3. Money used from selling of nationalised industries shares to the public would encourage people to participate in the economic and political life in the country.
Previous to the Thatcher era relations between government on unions, irrespective of which party was in power, were good however the New Right, under Thatcher was hostile toward trade unions.
This was credited to 3 main factors
1. Fear of the unions. The minor strike of 1974 brought about the downfall of heath government .Strikes in the winter of 1978-79 discredited the labour parties James Callaghan while he served as prime minister
2. believe that trade union activities distracted the working of the market allowing growth in the wages to out strip growth in productivity and were therefore responsible for reducing competitiveness in industry, which shouldered the blame for Britain economic decline
3. New right believed that incomes policies were a cause of inflation rather than cure, inflation could be reduced by monetary control not by trade unions agreement.
It has been suggested that Margaret Thatcher led a crusade to bring about the downfall of the trade unions and speculation as to whether or not she succeeded. Legislation was drawn up to curb the power of the unions.
(“Jones(1994:204) argues that legislation such as the education reform act of 1988,the children’s act 1989 and the national health and community care act 1990 expressed a Thatcherite approach in relation to social warfare that amounted to;
· Limiting financial expenditure on state health welfare and education provision
· Breaking up large public welfare agencies
· Increasing the scope of the private sector
· Bringing in business management and ideas to influence the running of health and welfare services
· Reducing the power of health and welfare professionals over how services were run and budgets spent.”) Bently, R. et al(1997) British politics in focus .Causeway press.
In a passage from her memoirs, Margaret Thatcher writes;
(“Welfare benefits distributed with little or no consideration of their effects on behaviour, encouraged illegitimacy facilitating the breakdown of families and replaced incentives favouring work and self reliance with perverse encouragement for idleness and cheatery.”)(Thatcher, 1993,p8)
This echoed sentiments ideology of previous conservatism and liberalism and suggested that Thatcher, and therefore Thatcherite ideology was hostile to the idea of the welfare state.
When John Major, Thatcher’s successor, failed to win the 1997 election for the conservatives, the new labour government under the leadership of Tony Blair inherited a radically restructured range of services.
Claiming commitment to maintaining ‘high and stable’ levels of employment and heralding a return to the vision of Beveridge. Lowe, R.(1999) The welfare state in Britain since 1945.2nd ed., London: Macmillan Press ltd.
Significant changes to aspects such as employment patterns, living standards, gender relationships, family structure and cultural diversity have meant development in pursuit of achieving ‘the Beveridge vision’ involves instigating modern policies as opposed to those of the past in the view of New labour.
In the parties 1978 manifesto Blair stated:
(“New labour is a party of ideas and ideals but not of outdated ideology.”) (Labour party,1997,p44).
This statement was intended to reinforce the belief in commitment to traditional socialist beliefs.
Critics of Blair have hailed him the true heir to the legacy of Thatcherism.
New labour or Blairism as it is sometimes called, in ideological and social policy terms is viewed as post Thatcherite (Driver and Martall (1998)
(“The achievements of Thatcherism are important to the ‘New labour Project’ and its approach to social policy”) Walsh, Stephens and Moore.(2000 p,54)
Supporter’s of Blairism’s ‘The third way’ adhere to the belief that in ideological terms it takes the best from Liberalism, social reform and social democracy, while critics would infer that ‘Blairism’ is ‘Thatcherism’ dressed differently.
In conclusion since the beginnings of social welfare reform in Britain in until today there are reflections through each party of conservative , liberal and socialist ideologies all of which continue to reflect archaic class structures predating the Victorian era favouring the middle classes and those of affluent social standing and discriminating against those belonging to the lower echelons of the British class structure .It is now widely agreed by all party’s in Britain that radical change is required in order to eliminate inequalities in health and social welfare .