Explain the role that different ideologies have played in the important developments in the NHS, and assess their arguments as to how the NHS should be reformed today.
In the history of the creation of the NHS, different ideologies have played different roles. The two ideologies are of the social democratic approach and the market liberal approach. The social democratic approach being that people should pay their taxes and the welfare state should provide health services for all, whereas the market liberal’s ideology was that people should pay for their own health services independently. In this piece of writing, I will be aiming to discuss how these two different approaches have played the all fundamental role in the way that it has developed the NHS. I will also assess the arguments, as to how the NHS should be reformed today. How does and does our current government have the all crucial key to make or break the NHS?
Social democratic ideology was that the government should have the responsibility of providing welfare provisions to the state through taxation. This would be creating a redistribution of wealth; poor people would have access to unlimited healthcare at the point of need. They wanted to create a more equal society through the redistribution of wealth. They wanted people to have access to healthcare on the basis of their needs, not on their ability to pay. (Brown, K, 2003)
The New Right approach or also known as the Market Liberal approach, (which developed during the Conservative government between 1979 and 1997), this approached believed that the individual had the right and freedom to choose their welfare provisions and should have the responsibility of obtaining it through private sector. They were against the idea of providing welfare provisions for all through taxations. They believed that taxations should be kept to a minimum and not be wasted on providing to those who can support themselves. The poor should only be provided with these welfare provisions and the rest of the population should be paying for their own healthcare through private medicine. (Brown, K, 2003)
Health and Society in Twentieth Century Britain, by Jones (1994) wrote that in 1945, Aneurin Bevan, Labour Health Minister put forward proposals that all charitable and voluntary hospitals should be taken under government control. These hospitals were to be reorganised under the hospital governing system. The conservatives maintained that they accepted the NHS Bill, but strongly opposed Bevan’s proposal; they wanted voluntary and municipal hospitals to remain under local authority. They did not want these hospitals to be taken into the NHS, but to remain in private ownership. Initially, the doctors in the BMA resented the state control of the health services and salaried GP’s, but Bevan managed to win them over with his proposals. He proposed to the doctors that they would not all be given a salaried wage, but they would be free to practice in private medicine and offered private pay beds in the NHS hospitals. They would also be free to publicly voice their opinions about the management of the NHS.
It is described in Health and Society in Twentieth Century Britain, by Jones (1994), that following the years after the introduction of the NHS, the costs of it was being realised. Assumptions were made about the country’s set amount of illness, it was thought that at first the NHS would work through the backlog of people’s illness, but in the long term, it would be more cost effective having a country that is more healthier. In 1948, Bevan told his government that his original estimate was overly miscalculated. In 1949, the government had to economise either by reducing services in the NHS or introducing prescription charges. It was agreed that the prescription charges would be introduced. When the charges were presented, The Clement, Attlee, the Prime Minister, Bevan, said that the charges were a means to prevent the abuse of the system. It was when the charges of spectacles and teeth were introduced by the new Health Minister, Hilary Manquand, Aneurin Bevan resigned. These charges were thought to be introduced because of Britain’s involvement in the Korean War, which lead to consequences on Britain’s welfare. It was established that the acceptance of prescription charges was unavoidable as expenditure was overestimated.
It is stated in the Welfare State Political Issues by Annesley (2004) that after the war and during the economic boom, both Labour and conservative parties were in favour of the creation of the welfare state. It was thought that people had the right to vote and own a property and therefore should also have social rights. When the conservatives came into power in 1951, they did not want to be seen as the government who was ruining the NHS, Labour’s creation. They further increased prescription charges pointing out that Labour, the previous government that had initiated this.
In the Welfare State Political Issues, by Annesley (2004) describes that the post war consensus broke down in the 1970’s; the economy was slowing down due to unemployment. Margaret Thatcher came into power; she believed that the poor economy and high levels of unemployment was due to the welfare state. There was a consensus that there was too much spending on health services. The New Rights believed that the welfare state was creating a dependency culture by being generous towards people. If there was less generosity, than people would be more willing to work, therefore leading to a more efficient economy. They believed that people should be independent and should take responsibility for their own welfare provisions. From 1979, Conservative governments tried to dismantle the welfare state and to encourage individual responsibility for welfare. They did this by cutting the level of social security for the unemployed; those who demonstrated that they were actively seeking employment would receive social security. They stopped spending on social housing and encouraged people to private ownership by selling council homes at cheap rates to tenants.
It is said in the Welfare State Political Issues, Annesley (2004), that the conservatives also sought to marketise, they set up an internal market within the NHS, where some services would be contracted out to private firms, such as cleaning and laundry. They encouraged people to take out private health insurance. The conservatives tried to cut back on the welfare state, but during their 18 years in office, welfare spending rose. This was due to demand in healthcare and rising levels of poverty. Even though the party has ideologies that they wanted to implement, these were constrained by the fact that people favoured and supported the NHS.
Although the Labour party was devoted to the welfare state and high levels of public spending until the 1980’s, but than it led to review and alter its approach due to several electoral defeats. The labour decided to concentrate on promoting education and training and to transform the welfare state as more of a safety net, rather than spending and redistributing wealth due to economic failure.
The conservative leader, David Cameron made a pledge during the election campaigns of 2010, which the NHS is at the heart of the Tory manifesto (Guardian 2010). He made a pledge that there would be reforms in maternity services to (Cameron 2010) ‘meet the mother’s needs’. He also made a promise that he would spend more money in areas that were deprived of health services and he said (Cameron 2010) ‘Health inequalities in 21st century Britain are as wide as they were in Victorian times…we must target resources at the worst-off areas’. He also said that he would make improvements in the NHS, while tackling the countries deficits. He promised to protect the NHS if elected as a government and would increase spending on it. The conservatives said that the only way they could tackle the economical crisis is if everybody pulled together. (Conservative manifesto, 2010)
For the Labour party, Gordon Brown pledged to protect the NHS and provide a more patient centred approach. He pledged to secure the economic recovery by supporting the economy now and cut more than half the deficit by 2014 through the economic growth, fair taxes and cuts to lower priority spending. (Brown, Gordon, 2010)
The Liberal democrat’s economic plan was to reduce the economic deficit. In their party manifesto, they said that they identified ways of finding saving through cuts to eliminate the deficits. They pledged to spend more money on parts of the NHS, by cutting spending on other parts. Like both the Tories and labour, they wanted to work on more preventative measures on people’s health through their GP’s. (Liberal Democrats Manifesto 2010)
Before the NHS was created, hospitals were run by charities and had their own personal budgets that they had to maintain their hospitals and the patient care that they offered. These hospitals found it hard to manage their own funds and often became bankrupt. This is an example of where independent hospitals were not able to maintain their own budgets and finance, without the support of the government. In these situations, government had to intervene in the past.
David Cameron’s coalition Conservative/Liberal democrat government are aiming to make major changes in the NHS, even though the Conservatives pledged to stop the reorganisation of the NHS in their election campaigns, but now they are planning to make the biggest changes the NHS could experience. They are proposing to privatise parts of the NHS and give the GP Commissioning Consortia the ‘power’ to spend the money from the government on how they choose to. They argue that this would create competition in the NHS and create a better patient care and save money by cutting NHS administration. It is suggested that this type of competition will result in a more less patient centred approach because GP’s would be spending more time trying to decide how to spend or allocate the money and there is the question of whether they would have the time to fulfil the responsibilities that they would be given .
These changes seem to undermine the principles that the NHS was created, by creating a competition between the NHS and the private sector and giving the private sector equal standing to the NHS would haze the boundaries. The conservatives are claiming that the changes that they are making are merely being built on what the Labour government had started by introducing the private sector to the NHS and what they are doing is not a complete revamp. It could possibly work if the right strategies are implemented to ensure the successful execution of a pro-market NHS.
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