Lisa Florey
Arguments For and Against The State Provision of Welfare
For this assignment I have been asked to choose two of the five conventional social policy areas and provide a brief description of the current UK government service provisions in these two areas. Then to identify what I would consider being the main justification for and against retaining the services I have described.
I have chosen the following social policy areas to study:
- Health
- Social Services
Health
The National Health Service (NHS) came into operation in July 1948. It was a fully comprehensive system, which covered all forms of medical treatment. No one was charged directly for any of its services, including prescription, and no one was forced to use it. Patients could still pay for private treatment and doctors could practice in both areas. All hospitals, a part form teaching hospitals, were brought under Government control.
Health care in the UK provides:
- Primary Care
- Secondary Care, and
- Tertiary Care.
Primary Care Services
With the development of Primary Care Groups (PCGs) it is hoped that General Practitioners (GPs) will be able to identify needs in the local area and develop services that are required. The Primary Care Team includes the GPs, Health Visitors, Practice Nurse, Community Psychiatric nurse (CPN) and District nurses. Because the PCG Board includes representatives from the nursing staff, issues related to nursing care are being identified. Other practitioners offering services to the public are dentists, pharmacists and chiropodists.
Secondary Care
Hospital Trusts offer secondary care to patients. All Hospital Trusts are required to produce an annual report, covering statistics showing patients treated, financial details and developments in service provisions, both current and planned. With the development of the PCGs, commissioning services in the secondary sector is shared between the PCGs and the DHA (District Health Authority).
Patients are referred to hospital by their GP, except for attendance at Accident and Emergency (A&E), where many people are self-referred. S.T.D. (sexually transmitted disease) Clinics (sometimes called GUM (genito-urinary medical)) are attached to main hospitals and give free confidential advice to people with genito-urinary infections including HIV. Access to these is also self-referral. With the development of NHS Direct and Walk in Centres, there may be more diversity of ways of referral in the future.
Because of changes in technology, many hospitals can offer day surgery for routine operations such as removal of wisdom teeth, removal of cataracts and other minor surgery that requires a general anaesthetic.
Tertiary Care
These hospitals provide very specialised services such as cardiology, plastic surgery, and children’s cancer.
Social Services
Social Services provide a wide range of care and support for:
- Elderly people; (see next pages for the services that are available for the elderly)
- People with physical disabilities; (see next page for the services available for people with physical disabilities)
- People with learning disabilities; (see next page for the services available for people with learning disabilities)
- People with mental health problems; (see next page for the services available for people with mental health problems)
- People with drug or alcohol problems, and ex-offenders who need help with resettlements;
- Families, particular where children have special needs; (see next page for the services available for families)
- Child protection, including monitoring of children at risks;
- Children in care, through fostering, accommodation in children’s homes and adoption;
- Young offenders
What are the main justifications for and against maintaining the services identified on the previous pages.
Health
Justifications for keeping the services:
There has always been some sort of health service in the UK, but it was only available for those who could afford it. When the NHS came in to affect it meant that health care was available for everyone no matter what his or her position in society. As the health services developed the number of cases for specific diseases dropped dramatically. And it has also lowered specific statistics such as the death rate and it has also helped to increase our life expectancy.
Justifications against keeping the services:
Initially it was hoped that as preventive medicine developed, and the welfare services gave people a better chance of healthy life, the satin on resources would ease. Today it is more common to talk of a ‘crisis’ in the NHS and waiting lists for treatment in hospitals appear to be an increasing problem.
Fist of all people’s expectations about medical care may be altered. We have become accustomed to having the best possible treatment for all our illnesses, which is hardly a matter of complaint. Secondly, the frontiers of medicine have been pushed forward and the cost of modern treatment can be very high. A Wolverhampton Surgeon illustrated one example of the ‘problem’ in 1982:
“ We cam now save a limb crushed in a traffic accident but it may take four or more operations, five months in hospital and cost £20,000. A few years ago we would have cut the leg off and it would have cost £100,” (Sunday Times 14/2/1982).
A third cause of the crisis is simply that the welfare state has done its job well. The age structure of the population is changing as more and more people live longer. The increase in the number of old people has meant that more spaces have had to be used in hospitals for geriatric care. And again expectations are important. One key operation for many old people is hip replacement but waiting lists are growing.
The problem of an ageing populations has been made worse by the scattering of families since the world wars so that pensioners are less likely to be geographically close to their children. Increasingly old people have been taken into care, either in hospitals or homes, because there is no one to look after them. But in hospital beds in geriatric wards have their own waiting lists and state homes are full. Another effect is on NHS costs. It is estimated that a man aged between 25 and 44 costs the NHS over £82 per year. People over 75 costs the NHS an average, six times more than those between 24 and 45 years old.
Social Services
Justifications for keeping the services:
Social Services provide a wide range of care and support for various people, (as those stated on page 3). Social Services are also responsible for the inspection and registration of care homes and other services.
Social Services are the responsibility of 150 English authorities. Services provide by social services including the following:
- Assessing needs;
- Providing personal help;
- Social work;
- Day care facilities;
- Residential and respite care facilities;
- Occupational therapy;
- Rehabilitation;
- Supply specialist equipment;
- An emergency service, 24 hours a day, 365 days a year.
Justifications against keeping the services
Various legislations including the Mental Health Act (1983) and the Children Act (1989) has been implemented by the social services, but there had been a series of incidents where social workers had been blamed in the media for failing to identify and support children at risk.
Another problem is that different authorities interpret guidelines differently. For example, under the terms of the Community care Act (1990), serviced users were entitled to an assessment of their needs. Different authorities used different criteria when assessing users, payment for services varied.
After going through what I have written above, I believe that we shouldn’t keep the service I have looked at but I also felt that we shouldn’t get rid of them. Instead I believe the government need to take a long look t every part of Health and Social care services. I believe that they should reconstruct or do something to improve them further, so that there are no more incidents – for example what happened to Lauren Wright, aged six.
Bibliography
Alcock, P., Erskine, A., and May, M. (1998) The Student’s Companion to Social Policy, Oxford: Blakewells.
Alcock, P., (1996) Social Policy in Britain: themes and Issues, London: Macmillan press.
Thomson, H., Aslangul, S., Holden, C., Meggitt, C., (2000) Health and Social Care.
Department of Health (2001). Department of Health web page
Social Policy Assignment one
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