How Have Political Ideologies Helped to Shape Policy in the Healthcare Arena
During the late 19th and early 20th Centuries welfare and the provision of healthcare was dominated largely by a laissez-faire approach. Many people in Britain lived in impoverished and unsanitary conditions. By the time of the Boer War (1899-1902) nearly a third of all troops suffered from malnutrition and they were judged unfit to serve. This information was used by social reformers as evidence that Government ought to provide health and welfare services that were an improvement on those which existed at the time (Moore, 2002). Since then policy making has been shaped by the ideology of the Government that is in power. Different ideologies are associated with different political parties, the ones referred to in this paper are associated with Liberal and Labour Governments, Tory Government and New Labour. The ideological underpinnings of these political parties are respectively, social democratic, new right thinking and the third way. This paper will attempt to show how such ideologies have helped to shape policy in healthcare, beginning with social democratic policies which produced the 1942 Beveridge Report and laid the foundations for the British welfare state (Walsh et al, 2000).
Post-War Social Democracy
Social democracy is made up of a number of different strands but its policies are most closely associated with Labour Governments but is often subscribed to by most Liberal Democrats and some Tories. The Post-War Labour Government saw the Welfare State as central to society and one of the things that promoted social cohesion. Thus the ideologies of post-war Labour Governments are the basis of the British Welfare State (Giddens, 2001). The post-war Labour Government believed in universal welfare provision, where a high standard of welfare is available to all those who need them. This system results in what is known as an institutional model of welfare. Central to this approach is an understanding of healthcare as of a high standard, comprehensive, and available to all. Giddens (2001) notes that this kind of provision was based on the ideas of the economist John Milton Keynes and meant that Government was involved at all levels of people’s lives.
The post-war welfare state was formed on an understanding that there would be full employment. The 1942 Beveridge Report recommended the introduction of a system of National Assurance. Under this system everyone paid a part of what they earned to the Government and theoretically this would finance the welfare benefits they obtained. The National Health Service grew out of the publishing of by In 1946 Anuerin Bevan introduced a National Health Services Bill from which grew the National Health Service. Underlying this was the idea that healthcare and hospitalisation would be provided free at the point of access. The National Health Service, which was established in 1948, became the envy of the Western world as people received free primary care from their local GP, free medicine, free eye and dental care and free hospitalisation. By the 1950s however, it was becoming impossible to sustain a completely free service and the Government were forced to introduce some charges for prescriptions, spectacles and dentistry. This was largely due to the fact that the demand for healthcare exceeded Government resources to pay for it. The NHS lurched from one financial crisis to the next because the demands on it were so great (Walsh et al, 2000). Moore (2002) maintains that until the late 1970s British social policy was dominated by this approach which opposed radical change and believed that the best way to achieve a more just an equal society was over a period of time. However, the post-war government had not envisioned rising unemployment and reduced tax revenues. The Social Democratic approach has been criticised as being paternalistic and elitist, telling people that the state knows what is best for them. This approach has also been accused of creating a dependency culture rather than allowing people to think for themselves. This was a central argument of the New Right.
The New Right Approach
The Tory Government that was voted into office in 1979 argued that under the previous Government state services had become oppressive and inefficient. New Right thinking lay behind the Government’s policies, which in turn influenced its critique of Social Democratic policies and the welfare state. New Right approaches emphasise the role of the private sector in service provision. The incoming Government was concerned with the spiralling costs of welfare, particularly the health service, and the fact that people relied to heavily on Government services. Universal provision had created a nanny state a welfare dependency. Thatcher argued that it was preferable to provide services through the market, through charity, or through family members. Personal responsibility and self-reliance were the core values promoted by the Tories. The New Right Approach concentrated on lifestyle and its physical and mental effects thereby placing responsibility for the state of an individual’s health on their own shoulders (Giddens, 2001).
The new Government introduced market principles into the health service. Instead of doctors and patients, the term healthcare providers and clients were introduced. In theory this was supposed to give people more choice over the type of care they received, in practice it was a roll back of services. Stiglitz (2002) maintains that rather than increasing user choice the system actually gave the Government more control over people’s lives and allowed them to monitor take up of services to cut costs. In order to control spending on health competing NHS Trusts were introduced. This meant the growth of a two tier system within the Health Service and the introduction of private care (Walsh et al, 2000).
The Conservatives also began a process of deinstitutionalisation, closing geriatric wards and psychiatric hospitals, discharging people into the community. In 1990 the Community Care Act was introduced. Means and Smith (1994) have argued that this Act did anything but care,
…the term community thus enables the continuous construction of an idyllic past of plenty and social harmony which acts as an immanent critique of contemporary social relations. Thus the call by politicians and policy makers to replace present systems of provision with community care feeds into this myth by implying that it is possible to recreate what many believe were the harmonious, caring and integrated communities of the past (Means and Smith, 1994:5).
The New Right approach to policy making has been criticised at a number of levels and some research studies e.g. Howarth (1999) found that since 1991 the mortality rates in some local authority areas have risen by 40% and are thus significantly higher than the national average. When New Labour came to power they continued the critiques of welfare dependency and introduced further reforms. Their approach is not yet fully developed but is known as the Third Way.
The Third Way Approach
Dean (2003) maintains that when New Labour came to power in 1997 they did not break with New Right approaches. Blair maintained that they were offering a third way, that broke with the old left and agreed with some of the Conservative policies. New Labour ministers have argued that new policies are needed to cope with poverty and inequality and to improve education and health. Blair’s Government argue that the state cannot provide everything and people need to be ready to help themselves more. The Government will however, provide funding and opportunities for people to help themselves. New Labour have continued using market principles in healthcare and have introduced a system which accounts for the number of cases that a hospital trust deals with. Its healthcare policies also involve using the private health system to cope with the overflow work that comes from the NHS (Moore, 2002). New Labour still hold to the view that the introduction of market principles into the healthcare system will result in greater efficiency and better care.
Critics have argued that the inequalities under the Conservatives have continued under New Labour and there is now a postcode lottery within healthcare i.e. where a person lives determines the amount and quality of healthcare that they receive. In response to this the Government set up Health Action Zones in 1998. By 1999 these were focussed on underprivileged areas where the health of the population was thought to be particularly poor. Health Action Zones are based on the principle of inter-agency working i.e. health is not simply a matter for the NHS, voluntary organisations, GPs and housing and social services all play a part in promoting health. The Government also introduced NHS Direct, a telephone help service that people can contact when they are not clear what to do about a health problem. In some areas there are walk in health centres staffed by nurses, they deal with minor health problems and take some of the load off of A&E departments. (Moore, 2002). Some critics argue that Third Way policies benefit the better off at the expense of the poorer members of society.(Alcock, 1997)..It is also argued that Third Way polices are not sufficiently though through and therefore appear indistinct.
This paper has looked at the ways in which political ideology shapes policy making. It has focussed on policy making in health because this is still a hotly debated topic in both the media and in the public arena at large. Social democrats believe in universal welfare provision but the idea is based on full employment and that is no longer a viable concept. New Right thinking is against such total provision and believes that individuals need to be more self-reliant. Third Way policies use a combination of approaches but in practice much of the policy making is virtually indistinguishable from that of the New Right. Clearly these ideologies do have an effect on policy making, but more importantly they have an effect on the lives of British people. While there were many weaknesses in the Social Democratic approach it seems to be the general view that health services have deteriorated considerably with changing ideologies.
Alcock, P. 1994 “Back to the Future: Victorian Values for the 21st Century” in Murray, C. 1994 Underclass: The Crisis Deepens London, IEA
Dean, H. 2003 “The Third Way and social welfare: the myth of post-emotionalism” Social Policy and Administration Vol 7 Issue 7 p.695
Giddens, 2001. 4th ed. Sociology. Cambridge, Polity Press
Howarth, C. 1999 Monitoring Poverty and Social Exclusion 1999 York, Joseph Rowntree Foundation
Marsh, Keating and Eyre et al 2000 2nd ed. Sociology: Making Sense of Society Essex, Pearson Education
Means, R. and Smith, R. 1994 Community Care, Policy and Practice London, Macmillan
Moore, S. Scourfield, P. Sinclair, S. Burch, S. and Wendon, B. 3rd ed. 2002 Social Welfare Alive Cheltenham, Nelson Thornes.
Stiglitz, J. 2002 Globalisation and Its Discontents New York and London: WW Norton & Company
Walsh, I ed. 2000 Sociology: Making Sense of Society. Edinburgh, Prentice Hall.