Sociology Assignment:
The Development of the Welfare state and the National Health Service in Britain
Task 1
* In pairs produce an A3 poster describing the key developments linked with poverty during the years 1600-1940
See attached sheet
* Individually, describe in more detail two of these key developments
Key Development 1: The Elizabethan Poor Law of 1601 (‘Old Poor Law’)
The Poor Law of 1601was introduced as a response by the Government to rising levels of concern over how ‘the poor’ should be supported. As a result of several poor harvests, and soldiers returning from war there was increased vagrancy which concerned the Government who were increasingly worried about the possibility of social disorder and revolt. Under The Poor Law of 160, each parish was made responsible for its own parishioners that were impoverished, frail or handicapped and in need of support. Each parish became obliged to relieve the old and the helpless, to provide work for those deemed capable but who were finding it difficult to find work in their usual trade. The parishes also became responsible for helping to support unprotected children, often by introducing them into apprenticeships at a young age. The funding for providing this was collected by a ‘Parish Administrative Unit’ which was responsible for collecting poor-rates from the other parishioners. This was a form of revised local tax which was means tested and calculated, collected and then allocated and distributed by unpaid Churchwardens or Parish Overseers (later known as Relieving Officers) who were elected by the parish vestry every year.
There were two types of relief provided for the needy, ‘outdoor relief’ (through money, supplies of materials such as flax/ wool to provide a skill from which they could make money and work, or as basic foods such as bread) or ‘indoor relief’ (which included various form of institutional care). Outdoor relief was normally offered to people who were temporarily out of work (e.g. due to seasonal demand of their trade falling), or to fund the cost of a physician to treat those who were sick. Indoor relief was provided in different forms, depending on the classification of the pauper. Three types of poor people were identified in order to assess whether or not and to what extent people were in ‘genuine need’, and to evaluate the most appropriate ways to provide relief to suit what the individual was seen to require. The first group were ‘The Impotent Poor’ who were disabled, chronically sick, blind or mentally ill. They were viewed as being poor through no fault of their own and were seen as deserving relief. This was often provided in the form of admission to ‘houses of dwelling’, almshouses or poorhouses instead of workhouses.
The second group were ‘The Able-bodied Poor’, who were the unemployed but that were deemed as able to work. They were placed in work-houses where they were given basic labouring jobs in return for food until they could return to their normal work or find an alternative job. The third group were ‘Persistent Idlers’. These were the able-bodied who either refused to work, persistently quit jobs or regularly absconded. As a punishment for this ‘idleness’ they were placed in Houses of Correction which aimed to teach idle citizens how to become respectable through a strict regime of discipline that often involved flogging and beating.
Very few changes were made to the Poor Law Act 1601 until the late 1700’s (The Gilbert Act 1782-relating to workhouse unions), but the provision of outdoor relief for the poor gradually declined and the workhouse system was favoured as an alternative as it saved the parish money, and also acted as an incentive for the able-bodied poor to find stable work (as they received no income in the workhouses and were given very low status) and to discourage continued reliance on parish relief.
Key Development 2: The Poor Law Amendment Act (1834)
By the early 1800’s little changes to the original Poor Law of 1601 had been made, and there were many criticisms of way it worked and the way in which relief was offered. In 1832 there were 1.5 million paupers in England (10% of the population) and it was felt that the existing Poor Law was not doing enough to reduce the problems of poverty and pauperism. The cost of providing for the poor had increased substantially and people claimed that it but an unfair expense on the mostly middle-class rate payers who had to fund the welfare provision through local property taxes. The standards of relief in the workhouses varied greatly, in some the conditions were very poor, while in others the standard of living was often higher than that of the working rate-payers who funded them (‘pauper palaces’). It was also claimed that where the standards of living in workhouses were high, the benefits of using relief encouraged idleness and discouraged personal independence.
The Poor Law Amendment Act was introduced in 1834 in response to these concerns and primarily aimed to deter the able-bodied from claiming poor relief but continue to provide relief for the ailing and the helpless. There were four main recommendations of the new act. Firstly the issue of ‘Centralisation’ whereby local overseers would remain involved in poor relief but would now be accountable to a Central Board of Control who would hold overall responsibility for the care of the poor and needy. The second was that of ‘Uniformity’. Care provided would be of the same standard regardless of where in the country it was offered. This meant that the Elizabethan Settlement Acts (where paupers were returned to their place of birth to receive support) were no longer needed. This aimed to reduce the discrepancies in the levels of care provided in different areas, with affluent areas having better services than poorer districts. A ‘Workhouse Test’ was introduced under the Poor Law Amendment Act, which was a self assessment test. The only form of relief that was to be offered to the able-bodied poor was a position in a workhouse so a person either had to accept the hard regime of a workhouse or remain independent and live with the consequences. It was hoped that this harsh system would discourage those who did not genuinely need support from claiming it. The payment of outdoor relief was not abolished altogether (despite attempts to do so), although it was now available to far fewer, very rarely to any able-bodied poor and often only to the chronically sick to pay for medical care.
The conditions within workhouses were to change also under the ‘Principle of Less Eligibility’, introduced as a means of social control aiming to reduce the desirability of claiming state welfare (as it was seen as affecting the work ethics and people’s independence). The conditions in a workhouse in terms of diet and living conditions would at all times be maintained at a lower level than those of the lowest independent worker, so that entering a workhouse was only preferable to starving to death. Often inmates had personal belongings confiscated, were not allowed chairs to sit on and could not receive gifts of any sort.
These amendments are characteristic the Victorian attitude towards pauperism, that it is a result of a combination of self inflicted circumstances. There were two main themes of the Poor Law Amendment Acts in dealing with the poor, one of providing a caring role (for those in genuine need) and one as a deterrent role (in making the prospect of claiming welfare less attractive to encourage people to find their own way out of poverty). IT has been since argued that the Poor Law Amendment Acts instead of actually being aimed at reducing poverty (as was claimed), was more about finding means to deter pauperism.
Task 2
* Analyse and evaluate the changes to both the welfare state and the National Health Service from their beginnings to the present. Ensure that you focus particularly on the changes under the Conservative Government, as these were major reforms. Link with previous and subsequent changes. (Essay)
The Welfare State in Britain emerged when the Labour Party came to power with a landslide victory in 1945. In a bid to introduce a more organised system of tackling poverty and providing welfare support than the existing methods that had been developed of the preceding 50 years (which were still based on the Poor Law Acts). The government actively acknowledged, and recognised the importance of reducing the inequalities that existed between different groups in society and in different areas of the country, such as in levels of unemployment, accessibility to public services and the numbers of workers covered by occupational Insurance (for times of unemployment, illness etc). The principles and development of the welfare state were largely shaped by the work of academic civil servant William Beveridge. Beveridge rebelled against the theories of Adam Smith which had underpinned the provision of welfare under the previous Conservative government. Smith argued that individuals should be in control of their own lives and make their own choices, and in this way natural order of different classes would result, with capitalists owning industries and companies that a labouring force would support. Accordingly, he believed that there should be minimal (if any) government intervention in solving societal problems of poverty and healthcare- a stance which many socialists believed exploited and oppressed lower classes. Beveridge agreed with this, and also proposed that if the government was to take a more active and involved role in combating societal problems, the results would benefit not only the health and wellbeing of the population, but also the countries economy as an improved welfare and health system would lead to a healthier and more productive workforce (based on Keynesian theories of economy). In 1940, Beveridge was commissioned to lead a team to investigate outstanding welfare provision, and to draw up a plan for an improved system of welfare provision in the UK. The Beveridge Report, published in 1942, identified 5 giants (Want, Ignorance, Idleness, Squalor and Disease) that need to be reduced and eliminated, and devised a comprehensive system of social security in order to do this. The main feature of this system was social insurance, where all working men and women are obliged to pay a contribution into a national fund which would in turn guarantee them government support in times of hardship such as unemployment and illness. In addition to this the plan also allowed for a non contributory assistance scheme (means tested), child allowances, family allowances and included strategies to improve the education system and council housing- all which would improve the overall welfare of the population. The impact of the welfare state became apparent between 1945 and 1948, when Beveridge’s concepts (national insurance, educational reform, family allowance etc) began to be implemented and the issues of the 5 giants began to be addressed and slowly improved. This was through legislation, in particular the Education Act (1944), the Family Allowance Act (1945), the National Assistance Act (1948), the Children’s Act (1948) and the Housing Act (1949). One of the 5 giants identified by Beveridge was Disease, and his report proposed that a comprehensive accessible health service, matching that of the welfare system. He thought that the health provision available was fragmented and disorganised, and there was often the littlest care available in the areas most in need. In 1943 the Minister for Health Ernst Brown introduced proposals for a unified health care system with a central government department responsible for the service which would be advised a council and administered by local government areas. In 1945 a new Labour Government was elected and in 1946 a Bill to introduce a National Health Service based on the concepts of Beveridge was passed by Parliament. On 5th July 1948, the National Health Service first came into effect, with the principles that services would be funded from general taxation and that they would be free at the point of use, comprehensive and available to all, regardless of ability to pay. The original structure of the NHS was ‘Tripartite’ with three arms. The first arm was hospital services. Hospital care was overseen by 14 Regional Hospital Boards which funded 377 local hospital management committees, but the teaching hospitals had their own board of governors and were responsible to the Ministry of Health. The second arm was community and public health services, including maternity/ child welfare, home nurses, ambulances and health prevention/ promotion which continued to be run by separate Local Health Authorities or Councils (which were also responsible for housing, roads and education). The third arm was the Family Practitioner Services. A national network of General Practitioners was established, who were responsible for personal primary health care (including dentistry, optical services and pharmacists), and were also responsible for referring patients to other services (e.g. to hospitals) when needed. They were provided with contracts from 138 executive councils which received money to fund the services directly from the Ministry of Health. The salary structure of GP’s was changed and fees were now set and paid nationally. As can be seen, although the three strands were financed centrally (through the Ministry of Health- Government money), they were managed separately.
Although the introduction of the NHS had been a success, at this time as a result of war; food was still rationed, building materials and fuel were in short supply, and the economy (worldwide) was unstable. There was also a shortage of housing and as new densely populated areas were created, these too needed health services. It was also founded at a time when advancements in the availability and sophistication of drugs was occurring. Better antibiotics, anaesthetics, diuretics for heart disease, and advancements in equipment such as radiology meant that the cost of providing the NHS was increasing fast. Public expectation of the NHS continued to grow, more mothers wanted to give birth in hospital, and people expected the most advanced treatments available. Within three years of creating the NHS, the government was forced to introduce some small fees, going against one of the key principles of ‘free for all’. Prescription charges were introduced in 1952 (5p). At the same time a £1 charge for all general dentistry was introduced, as was a payment towards the cost of glasses. In an attempt to keep the NHS as ‘universal and free’ as possible without costing too much, the government set up the Guillebaud committee. Their report, ‘The Costs of the NHS’ (1956) highlighted the need for GP’s and Hospitals to work closer together so more people can receive care in home (less expensive), that the elderly should be dared for where possible at home also and that preventing illness should maintain a priority, but fundamentally that the given the circumstances the NHS was providing the best service possible and should continue along the same lines.
During the 1960’s a number of reports were published, looking at various aspects of how the NHS was structured organised and run. It was seen at this time that the three branches of management (hospital authorities, local authorities and executive councils) were not working together on some aspects of patient care, such as long term care fro the elderly which included all 3 branches of provision. The Porritt Report 1962 highlighted this and called for the NHS to be unified and the tripartite structure to be abolished. Although there were now consultants trained in the major specialties throughout the country, hospital buildings they worked in were outdated and damaged by the war, affecting patient treatment and staff training. The distribution of hospitals was also poor, with large well equipped hospitals in cities but poor services in rural areas. The Hospital Plan published in 1962 put forward a 10 year programme for developing District General Hospitals for areas with a population of about 125,000. As this plan was put in place, patients began to benefit from the larger supply of local services. The relationship between the medical profession (GP’s and hospital staff) and the Government had gradually improved, but there was still disagreement over pay under the NHS. A contract under The GP’s Charter provided financial incentives for practice development, and the position of a General Practitioner was acknowledged as a speciality. Doctors started to join together in partnerships and groups and form what we now know as ‘group practices’. The status of the nursing role increased also with The Salmon Report detailing a career structure for senior nurses in hospital management. The Cogwheel Report 1967 focussed on the organisation of doctors in hospitals. It encouraged medical staff to take a more active role in management by forming speciality groups which would arrange clinical, administrative and managerial problems more logically. On the 1 November 1968, the Ministries of Health and Social Security joined to form the Department of Health and Social Security (DHSS), the first step in the reorganisation of the NHS away from the initial tripartite structure towards a more combined system of management.
It was acknowledged that a new system which would distribute resources more fairly, improve management and better co-ordinate health and social care was needed. The cost of the NHS had continued to rise, by the mid 1970’s it was costing £6879 million per year compared with around £433 million in 1953. The newly appointed Conservative government continued to plan the reorganisation and the 1973 National Health Service Act started the first major reorganisation of the NHS although it did not come into practice until 1 April 1974. The main aims of the reorganisation were to unify health services under one authority (away from the previous 3 branch management structure), to coordinate health and social provision from the government by creating joint consultative committees, and to improve general management. Under the new Act, 14 Regional Health Authorities (in theory covering all 3 ‘arms’) were created in England to plan local health services and replace Regional Hospital Boards. Below them, 90 Area Health Authorities (consisting of members appointed Regional and Local Authorities and a Chair appointed by the Secretary of State) were appointed to liaise with local authorities, family practitioner services and district health authorities that managed the hospitals. Community Health Councils were introduced also to represent the public. In theory this was to be a more effective system as Health Authorities could plan and arrange all services and communicate with local authorities, but in practice there was too much managerial/ administrative based decision making which lead to delays, there was disagreement between District Management Teams and Area Health Authorities and administrative costs rose.
In 1976 a Royal Commission on the NHS was appointed investigate how the resources available to the NHS could best be used. In the mean time it was very apparent that the distribution and quality of health services varied significantly throughout the country. To address this, the Labour government set up the Resource Allocation Working Part (RAWP) to create a process of redistributing resources from well-off areas to the more deprived areas with more health problems (which continued until 1991). The Royal Commission Report was published in 1979, highlighting many issues but also suggesting that although the service should remain free at the point of delivery, more emphasis should be placed on health promotion and illness prevention. It also recommended that there should be just one tier of administration below the regional health authority, resulting in the Health Services Act 1980. As a result in 1982 the NHS was again reorganised, with the creation of 192 new District Health Authorities below the 14 regional health authorities. Between 1983 and 1985 a general management system was introduced (response to the Griffiths Report) as the previous system continued to be criticised, and doctors and other medical staff became more involved with financial and budgeting decisions. Despite the changes the financial problems of the NHS continued and by 1987 due to exceeding budgets, Health Authorities were in debt, waiting lists grew, and beds closed due to lack of resources.
The 1989 White Paper ‘Working for Patients’ was the Conservative’s attempt to improve the NHS by introducing an internal market system. The White Paper resulted in The NHS & Community Care Act 1990 and the 1991 NHS Reforms. As a result, the roles of the Department of Health, Regional Health Authorities and Health Authorities changed as more decisions were being made at local level. The Family Practitioner Committees were now called Family Health Service Authorities and they worked with District Health Authorities to administer primary care services. Health Authorities would now stop running hospitals directly and would need to ‘purchase’ healthcare with budgets from ‘providers’ (acute hospitals, special homes for the elderly, mentally ill, or ambulance services). Some GPs had smaller similar budgets to purchase some care. To be a ‘provider’, health organisations had to be NHS Trusts which would compete with each other and by 1995 all health services were provided by these Trusts. This system is based on the system in the United States, and supporter’s claim that is it more cost efficient as the Trusts are in competition so lower costs result. It also gave trusts more control over buying and selling property, and by 1997, through going into partnership with private companies and hospitals, 14 new hospitals had been built. Supporters also claim that it gives fund holders better choice of what services to ‘purchase’, and gives hospital managers more flexibility in paying, hiring and sacking staff so services remain efficient. There was however criticism that it was a shift towards a private health system and that the ‘free for all’ initiative was being overridden. Critics also claimed that more public money had been used to buy private services (at higher cost), hospitals found caring for elderly too expensive so services reduced, that the numbers of managerial staff (on high wages) had increased (by 10,000 in 3 years) while the numbers of medical staff had fallen, and that many services were duplicated creating unnecessary cost. The objectives of ‘Working for Patients’ also included involving clinicians in controlling budgets, and introducing an auditing system and a system to assess the quality of treatments in different areas. Despite all these changes to the structure of the NHS, costs increased from just over £775.4 million in 1991-1992, to £1,045 million in 1994 (cited from ‘The Guardian’, 6 June 1995).
By 1997 it was clear that by making the NHS more business/ market orientated and less needs-based, health care provision had suffered. In May 1997 the Labour government was elected and later the same year a White Paper, “The New NHS: Modern, Dependable” was issued in another attempt to reform the NHS. Again the structure was to change, and the competitive internal-market system was to be replaced by a system based on partnership, driven by performance and improved patient care. ‘Primary Care Groups’ (each in charge of healthcare for about 100,000 people) replaced GP fund holder’s (reducing the inequality of services), but the provider/ purchaser system remained as it was viewed as cost effective.
Since the late 1990’s, there have been yet more changes (financial and structural) to create a more coordinated NHS for the 21st Century. After the ‘Wanless Report’ it was acknowledged that the NHS has been and still is very under funded, and the government launched ‘The NHS Plan’ (July 2000), a 10 year action plan of investment and change, promising a 6.3% increase in spending per year until 2004. In order to ‘put patients first’, more beds, doctors and nurses were promised as were cleaner wards, greater patient choice, better care for the elderly and shorter waiting times. In April 2002 ‘Shifting the Balance of Power’ reformed the structure of the NHS in a bid to ‘put patients and staff at the heart of the NHS’ (cited from http://www.nhs.uk/England/AboutTheNhs/History). As a result of this, Health Authorities were replaced by over 300 Primary Care Trusts who were responsible for health promotion and illness prevention through integrating aspects of health and social care and to reduce inequalities. 28 new Strategic Health Authorities were created under the Department of Health and Modernisation Agency), to support the Primary Care Trusts (responsible for GP’s, Walk-In centers etc) and Secondary Care Services (NHS Trusts, Care Trusts, Ambulance Trusts etc) in their area with the NHS Plan and to monitor all other local health agencies, creating a single structure where all l NHS organizations are accountable to a Strategic Health Authority. Other changes that have occurred since the late 90’s, include the establishment of more regulatory authorities to monitor patient care and the system generally (e.g. NICE) and award systems so patients are aware of improvement in their services. Projects to computerise the NHS are also underway to improve access to records and moves towards increased care in the community are in progress for the mentally ill and elderly.
As can be seen, many of the problems present in the early days of the NHS, such as how to manage, fund and organise the system best, how to balance the demands of patients and staff, and how to allocate funding are still key issues today. I believe that as the health needs of the population change, so to will the structure and services of the NHS.
Task 3
* With reference to the bar chart ‘Rates of Child Benefit 1977-2003’
a) Describe what the graph depicts in terms of the rates of child benefit over time.
The graph shows how the amount of money given by the government to families as child benefit has changed over the 26 years preceding 2003. From the graph it can be seen that the amount of money spent has increases substantially over this time since April 77 when just around £1 million of government money was given as child benefit, to over £15 million in 2003. This increase in spending has been fairly gradual and consistent over the years, although it can be seen that during some periods of time, spending has increased at a faster rate, while during other years it remained at the same level. From April 1987 to April 1991 the amount of money spent by the government on child benefit remained at just below 7.5 million pounds per year. This maintenance stage was followed by a period where spending rose quite substantially over a short period of time, by about £2.5 million form April 19901 to April 1993 (from around £7.5 million to just under £10 million /year). Between 1994 (when John Major came to power for the Conservative government), and 1998, spending increased very slowly each year until 1999 when (under the new Labour Government), the most significant changes in government spending on child benefit occurred. By April 1999, the amount of money spent per year had almost doubled in ten years (since 1989), from just under £7.5 million/ year to around £14 million/ year. From April 2000 and April 2003 spending continued to increase year on year but once more at a slower rate. From looking at the line of best fit drawn on the graph (to show the overall average trend of increase in spending), it can be seen that over this three to four year period, spending has increased year on year more or less at the same rate as would be an average over this 26 years.
b) Child benefit is said to be the cornerstone of Government financial support for families. However it can be argued that this only tells half the story. Discuss why the data provided in the bar chart may be misleading in terms of the total amount of Government money spent on child benefit.
The graph shows a substantial increase in Government spending on child benefit over a 26 year period which can be initially interpreted as significantly benefiting families, as they appear to be receiving more financial support. This graph could however be misleading as it does not take into account other factors and changes that have occurred over this time (both in terms of other Government support and spending and in society as a whole). Firstly, it is hard to analyse these figures as either positive or negative as information regarding other factors that may have an impact on families is not given. For example since the 1970’s, the cost of living has dramatically increased, and the value of money in ‘real terms’ has reduced (e.g. ten pounds nowadays not being worth nearly as much as 25 years ago, so with ten pounds you will now not be able to buy as much as with ten pounds in the past). The price of essential everyday items such as food, clothes, toiletries and utilities has risen steeply and this needs to be taken into account, as these things add to the price of raising children. Items specific for babies and young children have also gone up in cost as advancements in safety and technology have occurred so items such as sterilising units, push chairs, car-seats are now far more sophisticated and therefore more expensive. Due to increased awareness of disease and accident prevention, these items are now accepted as essentials and people would be worried not to use the equipment for fear of causing harm to their children, so whereas in the past people would have been more confidant to ‘make-do’ with second hand or more basic equipment, they are more nervous to do so now and spend money on these often very expensive items. Other changes that have occurred in society generally have had an impact on raising children also. More mothers now work (full and part time) to try and be able to provide better for their families, and while the extra income is an obvious advantage, other expenditure occurs as a result for example the cost of child care has risen greatly and is in higher demand, and the price of after-school clubs and activities has increased. All of these factors have contributed in a steep rise in the cost of rearing children, and as there is no data to show how and to what extent this cost has risen on the graph to show child benefit changes, it cannot be evaluated effectively as to whether or not the rise in child benefit corresponds to the rise in rearing costs, i.e. it may in fact be that cost of rearing children has risen far more than the rates of child benefit, so rather than families being in a better financial position, they are in fact worse off. Another factor that is not taken into account is the amount of families receiving child support. It could be that at the same time as the money being spent increasing, the numbers of people receiving the benefit has also increased. This is very likely to be the case, not because the birth rate in Britain has increased, but due to migration (more people are moving to the UK to find work/ leave regions of conflict/ find a better standard of life, often with their families). Because of this it could be that even though the government is spending more on child benefit, families are feeling the effects of this increase as the total amount is being shared among more people.
These confounding factors paint the picture that in fact families may be worse off than the figures suggest, and although child benefit is often seen as the main financial support for families from the government, this is not the case. Other changes in government spending over the years have occurred, many of which have benefited families and children. Child benefit is often seen as the cornerstone of governments financial support for families, as it is a benefit that anyone with one or more children under 19 living in the UK is entitled to as it is non-means tested. There have been many other forms of financial assistance and support introduced over the past 25 years that is available for families (especially since the Labour Government came to power). Most of these benefits aim to help those families who are most in need of support and so are means tested. There is now a range of benefits that help families in different circumstances at different times, for example Disability Living Allowance for Children, Child support Maintenance, Home Responsibilities Protection, Widowed Parent Allowance, New Deal for Lone Parents, Community Care Grants and Council Tax and Housing Benefits, as well initiatives such as free school meals being provided for children from low income households. All families may not be entitled to all these benefits, but families most in need do receive more financial aid, and those who are better off- less, so the system is fairer. The government spending on child benefit alone cannot therefore be seen as the fundamental financial support for families, as many families will receive other forms of benefits, both in terms of support for direct child costs and indirectly as support with utility bills, housing etc.
c) With reference to the article ‘Cradle Cash’ and other research undertaken, discuss the possible impact of such benefits for families with new babies and young children, on the welfare of these individuals.
Benefits available for babies and children have recently been increased for low-income families under the New Labour government in an attempt to reduce the number of children (and families) living in deprived environments, to ensure they have a good start in life. The Sure Start Maternity Grant (SSMG) provides women in the last stages of pregnancy (or first 3 months of motherhood) with financial support to equip them for providing for their young child. This has been increased from just £100 to £500, although it is still argued by pressure groups that this figure is insufficient to buy even the most basic kit for a child’s first 3 months, but undoubtedly it is a vast improvement on the previous £100. They have also implemented changes in that individuals can now still receive $10.45 Child Benefit, even if they are receiving Job Seekers Allowance, Council Tax or Housing Benefits. The Labour government has also implemented additional benefits for women during pregnancy, with a rise in the levels, and an extension in the amount of time that Maternity Allowance and Maternity Pay are awarded for. This money will benefit not only the mother (with living expenses), but will also indirectly have a strong impact on the child, as this money is designed in part to help provide mothers with additional money to buy nutritious and appropriate foods during pregnancy which directly affects the health of the child when it is born. Pressure groups however again claim that financial support during pregnancy is still insufficient. The Government also offers benefits for parents who are adopting a child, with those people now eligible for the £500 SSMG and Statutory Adoption Pay. This not only helps those children and families, but is also likely to encourage more people to consider adoption now they are entitled to more financial support. The most recent initiative is that of Child Trust Funds whereby each child will receive £250 from the government when they are born (£500 for low income families), which is directly paid into a tax-free savings scheme. Every year after that, the parents, families and friends of the child can add up to £1,200 a year until the child reaches 18. The intention of this scheme is that once the person reaches 18 years, the money can be used towards expenses such as university or renting or putting a deposit on a fist home. This system does however have flaws; the money is unlikely to significantly help with costs such as university expenses as the average student in the UK now leave University with debts of over £12,000. If the persons family invested the original £500 in the Child Trust Fund and did not add to it, the fund would be worth just over £1,400 18 years later (based on 7% annual growth-cited from http://newswm.bbc.co.uk/1/hi/business/4162185.stm) – clearly not a significant contribution to the £12,00 university debt. On the other hand, if parents were to invest the full weekly child benefit into the fund, it would be worth £27,000 (based on the same calculations). This does seem that future children will be in a better financial position on reaching 18 years of age in the future, but in reality, the children of families that are likely to invest the full Child Benefit into the Fund are likely to be those from better off families anyway, as other families will need to use the Child Benefit for the ongoing costs of bringing up their children and will not be in a position to be able to invest the money. This highlights the concern that this new scheme may end up being biased towards better off families who are in less need of support. There is also concern over how the fund will work in cases where children have been in foster care, or adopted, which could again mean that the most vulnerable and in need will not benefit to the extent they need in comparison to others. So, although the increases in benefits for babies, children and families will have improved the financial situations of many, it is only a small improvement and the cost of child rearing are still far higher than the benefits available. It is unclear also how much of a positive affect these proposed schemes will realistically have in the future, but more needs to be done to ensure that those most in need obtain the needed support, to ensure that children are not born or raised in deprived environments, and that families are able to provide their children with the best possible start in life.
Task 4
* With reference to the newspaper cutting ‘NHS Reveals Cost of Your Operation’ and the table ‘NHS Price List’, together with any further research you may wish to undertake, analyse and evaluate the current issues surrounding the debate on the cots of operations.
The government’s Budget of 2000 launched the NHS Plan which set out a ten year timetable of invested into the NHS in a bid to improve and reform the service so patients receive the best possible health care. However since then, although more money has been invested into the NHS, the costs of running the service have increased due to demand and the availability of more advanced and expensive treatments.
Despite the increased investment, there has been much bad publicity in the media regarding the state of the NHS, highlighting issues such as poor hygiene practice leading to the hugely publicized increase in the ‘super-bug’ MRSA, staff shortages, and long waiting lists and cancelled operations. Because of this, more and more people are taking out private health insurance or paying for their own treatment in private hospitals, and the NHS has over recent years resorted to contracting private hospitals, and paying them to treat NHS patients in an attempt to cut waiting times. It cost the NHS more than £100m last year to treat the 60,000 NHS patients in private hospitals, significantly (43%) more than if these patients had been treated in their own hospitals. It was also found that the cost of providing operations varied greatly, as some private hospitals charged the NHS more for the use of its services than others. In order to reduce this huge expense, but continue to be able to treat patients within an acceptable time scale, Health Minister John Hutton introduced a new National Tariff system to be phased in over the next four years. In this new system, there will be a maximum amount that a hospital can receive for carrying out a procedure, and if they go over the proposed price, they will have to pay the extra themselves. In a similar way, if they manage to carryout the procedure at a lower cost, they are able to keep the difference and reinvest the money (e.g. buy new equipment). Mr. Hutton claims that this will “reward efficiency and promote fairness” (cited from article by Abul Taher), “and will enable to patient to have greater choice about where and when they are treated” (cited from http://www.doh.gov.uk).
48 procedures are costed individually under the new tariff, including hip replacements and heart bypasses. As can be seen from the NHS price list, the costs under the 2008 Tariff are mostly slightly higher than the average current cost of the procedure, but what can also be seen is the variation in cost that there is at the moment, for example the cost of a hip replacement can vary by over £1200.
This new Tariff system is only one of the Government’s initiatives regarding how to improve the NHS, and at first glance appears a realistic and positive system for all, the patient (more choice and control and faster treatment), and the NHS (cutting costs).
To me, it seems a good theory, but there are a lot of factors that don’t seem to have been taken into account. The amount of money allocated to each of the 48 procedures is only at the higher end of the cost now, and by 2008 it is likely that the cost of the same procedure will be significantly higher due to further advancements in treatments and equipment, resulting in the hospitals being under more pressure to make cuts in other areas so that the cost of these procedures can be met. If that is the case, then the improvement in waiting times is likely to decrease the standards and performance in other areas of care. The system also doesn’t take into account that a heart bypass for one patient may be a lot more expensive than for another, for example, a young relatively fit man is likely to recover a lot faster, require less intensive care treatment, and may be discharged sooner than a 78 year old man with other complications. As the costing doesn’t allow for the additional after care expenses (just the operation itself), I would be worried that hospitals will try and chooses to treat the less complicated cases in order not to go over the budget, so some of the most ill patients may find it harder to find treatment.
I think this system does have benefits in preventing private hospitals from overcharging the NHS and ensuring patients receive their operations, but I think the cost to the hospitals will probably lead to them having to cut staff numbers (to save money) when there are already too few nurses and doctors in this country. I think it may also be biased against teaching hospitals, as if you are training new staff, procedures will take longer as they will be explained to the students, and therefore cost more. This might discourage teaching hospitals from allowing as many students to take part or observe procedures that would improve their future practice. In other words, although it seems to be improving a much publicized problem, some aspects of the tariff are unrealistic and the effects of improving waiting times are likely to have a detrimental affect on other areas of the NHS.
Bibliography
Books
Giddens, A. (1997) Sociology 3rd Edition. Cambridge: Blackwell Publishers Ltd
Chapman, S. (2001) Revise A2 Sociology. London: Letts Education Ltd
Moore, S. (2000) Social Welfare Alive! (2nd Edition). Cheltenham: Nelson Thornes
Class notes and handouts
Web addresses
http://users.ox.ac.uk
http://www.learningcurve.gov.uk
http://www.bbc.co.uk/history
http://www.webref.org/sociology
http://www.dwp.gov.uk
http://news.bbc.co.uk
http://www.cripplegate.com/index.htm
http://newswm.bbc.co.uk/1/hi/business/4162185.stm
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