Chapter 3 Managing Healthcare Britain

Chapter 3

Managing Healthcare: Case Study of Britain

Provision of public services in Britain – welfare state

Origins of the Welfare State

Before the 20th century, the British government did not provide much medical care for its citizens. The poor, aged or homeless had to depend on private charities, friends or family. They were unable to ask the government for help.

A welfare state is a system in which the government uses tax revenue to look after the welfare of its citizens by providing free social services such as health and education, old age pensions and financial support for the disabled and unemployed.

Early 20th century:

British government started giving assistance

?First to senior citizens in the form of a pension for their daily necessities

?Then to the unemployed and the sick

1942:

Sir William Beveridge, a civil servant, published a report calling on the government to

?Provide basic help for all citizens

?Put an end to poverty, disease and unemployment

After World War 11 (1945):

A period of high unemployment, poverty, shortage of food and fuel > British government acted on Beveridge's plans to create a welfare state to look after its citizens for life.

How the British government created a welfare state N HM SW

a) Nationalised public utilities and important industries

? Took over the management of public utilities like electricity and gas, port authorities, railway and bus companies, and the coal mining and steel making industries

? Aim: to create employment and ensure that these services remained affordable

b) Provided Health and Medical care

? Created the National Health Service (1948) to provide free medical and dental treatment for all citizens -> funds for the NHS were paid for from taxes and worker insurance payments

c) Provided Social Welfare benefits such as:

? Unemployment and sickness insurance

? Maternity and widows' benefits

? Family allowances for children up to age 16 (18 years if the child is still in school

full-time)

? Pensions for the elderly

? Subsidised public rental housing for the poor

Problems of the welfare state L R W B

a) Low efficiency

? Workers in government-owned companies had little incentive to make profits as they believed government could always provide more funds -> led to

- Low productivity of labour and poor service

- Loss of money and revenue

? Long waiting queues in the NHS

- High demand for free treatment --> not enough hospitals, doctors and nurses to deal with the increase

- More patients were seeking treatment for non-urgent cases such as dental treatment

b) Rising costs because of increase in government spending

? 1979: ?7 billion - 1983: ?14.7 billion

? 1997: health services comprised 17% of government expenditure and social welfare benefits some 32%

c) The 'why work' attitude

? Little or no motivation for the poor to work as they could live on welfare benefits such as unemployment a

nd housing benefits, and allowances for families with children still in school -> indifferent attitude towards work and personal responsibility

? Middle income group also had little motivation to work hard because of access to cheap medical care and free education for their children

d) Businesses driven away

? To pay for all the health and welfare services, the government taxed the rich and the businessmen heavily - some businesses moved their operations and employment overseas to avoid paying taxes

Results? Moving away form the welfare state

Mid-1970s:

British government decided they had to reduce the cost of welfare and medical expenditure

Late 1970s:

Politicians argued that:

?Both welfare benefits and cheap medical services were making British society weak and dependent

?The government could no longer shoulder the growing costs

1979:

Under Prime Minister Margaret Thatcher, the government started the move away from the welfare state by:

?Privatising public utilities and health care -> private companies now had to compete with others to make profits

Aim:

- To reduce reliance of companies on government to provide subsidies

- To save costs on public expenditure

- To make public utilities more efficient

?Reducing the extent of health and welfare benefits, e.g.

- People now had to pay for medicines, dental treatment and services provided by opticians -> exemptions were given to students below 19 years of age, expectant mothers and mothers with children under one year old

- Aim: To encourage citizens to take responsibility for their own welfare and health

The Future of the welfare state

?The welfare state in Britain still exists although in a modified form.

?The government cannot do away with the welfare state completely because it will lose the votes of the people who are against the idea.

?At the same time, the government is grappling with the problem of an ageing population -~ government cannot expect to collect the same amount of taxes -> makes it all the more crucial to curb government expenditure in public services

How government in UK is reforming the NHS

Have British healthcare policies met the needs of the people?

Swiss Cottage Secondary School

1

Secondary 4 Social Studies Notes, Humanities Department