The Welfare State
- How and to what extent the state provides benefits.
- Countries with strong welfare provisions tend to demand higher taxes
The Third Way
- A middle way between Thatcherism (authoritarinism) and 'old' Labour socialism.
- Updates social democracy (between unrestricted free market capitalism and centralised state socialism).
- Partnerships between public sector, private sector and voluntary.
- Exemplified under Blair.
- Overarching problems:
- 1997 economic recession worsened.
- Expenditure was reduced in all areas of the public sector.
- Thatcher would not increase taxes sue to her political ideology.
NHS Under Thatcher
- Considered the American model of healthcare with healthcare only being for the poorest members of society.
- Keen to encourage more people to take out private healthcare.
- Not prepared to increase funding on the service during economic difficulty.
- Thatcher was advised againts privatisation as it would be considered electoral suicide.
- Suggested not changing funding but changing internals of the service to make it more efficient.
- Would be the beginning to an essential reform of the NHS.
NHS Reforms Under Thatcher
- An internal market was introduced to create internal competitions between purchasers and providers in the NHS leading to greater efficiency and a better service for patients.
- Purchasers (GPs) were given money by the government to purchase services for their patients from their providers (Hospitals).
- Purchasers would want to recieve best value for money and the best service for their patents so the providers would be encourages to deliver services with greater effciency.
- Quasi-privatisation - a reduction in quality due to purchasers wanting best value for money when buying from providers.
- Charges for dental check and eye tests were introduced as a way to reduced costs.
- The Labour party accused the government of beginning the process of privatisation without being honest to the public.
- The NHS was still underfunded.
- The structure of the NHS had been changed for good and seemed further reform would be ineviatable.
Internal Health Market
- Why was it controversial?
- Became more about competition as providers fought for the GPs custom.
- Meant more focus was on saving money rather than actual quality of care.
- Fundamentally changed the NHS.
- Part privatisation.
- GPs could choose to be fundholding.
- Further increased local differences - offering varying quality.
NHS Under New Labour
- Took a steady approach to chaging the NHS - even after Blair stated there was '24 hours to save the NHS'.
- Decided to stick with Conservative spending plan for 2 years which delayed significant investments.
- No attmept to reverse a lot of the Conservative changes.
- Foundation status was introduced to the most successfull hospitals.
- Gordon Brown announced an extra £40 billion in funding for the NHS.
- Replaced the Internal Market (purchaser/provider) with PCTs.
- Introduced walk-in centres.
- Introduced star rating system (1-3) for hospitals - has however been dropped.
- Idependent sector treatment centres - operations purchased from private practices to reduce waiting times.
- Introduced the National Institute of Clinical Excellence - drugs testing.
- Increased use of PFIs
- Payment by result - additional funding if criteria were met.
- Payment by result:
- Aim: hospitals essentially paid per patient they treat in order to provide them with additional incentive to compete for custom.
- Encourages stronger incentives to ensure that extra money is being invested into the NHS.
- Not sufficiently patient focused, can act as a barrier to delivering integrated care.
- Independent Sector Treatment Centres
- Aim: to help the NHS reduce waiting times for planned operations and diagnosis checks.
- Gives people a seconds choice - choose and book.
- Controversial as it led to the quasi-privatisation of the NHS.
- Successful in the short term - gave better and quicker care for patients.
- Foundation Hospitals
- Aim: due to their high acheiving status these hospitals get funding direct form central government, they can make their own decisions over how to spend it.
- Streamlined the process of giving money to hospitals.
- Decisions made should be better for patients as they are more locally based.
- Can lead to postcode lottery as Foundation Hospitals can decide what treatment is available there.
- NHS Direct
- Aim: reduce time spent at GPs.
- Provide web based health information syste.
- Further reformed to NHS 111 to allow people to speak directly with health professionals.
- Counter producitve when combined with self-diaganosis.
- Could cause people to spend more time in GP offices.
- Walk in Clinics
- Aim: to reduced waiting times with no appointment clinics and allows people to get a quicker diagnosis.
- Helps to ease strain on A&E
- Fairly successful as more poeple visit them due to shorter waiting times.
- More specialised - sex health etc.
- Aim: private sector involvement in order to build and equip hospitals, care centres.
- Better facilites and higher quality of care for patients.
What is the Postcode Lottery
- A phrase used to describe the countrywide variation on the provision of dugs and treatement available on the NHS.
- Primary Care Trusts make decisions on how healthcare funding will be distributed in their area. Different arreas will prioritise differen services meaning that others will lack the funding required to provide another service to NHS patients.
- Tends to affect the poorer in society.
Francis Report 2013
- Provided a detailed analysis of what contributed to serious failures in care at Mid Staffordshire NHS Foundation Trust.
- Report identiftfied how the regulatory system failed to detect and adress the trust's problems.
- Led to a new offence of wilful neglect.
- Its findings have shaped healthcare policies.
Health and Social Care Act 2012.
- Pre 2013, 152 PCTs controlled local spending and accounted for 80% of the NHS budget.
- From April 2013 they were replaced with 200+ GP led organisations call Clinical Commissioning Groups.
- Responsible for closer to 60% of the budget and every GP is assigned to a CCG.
- GPs have day to day contact with patients and therefore are more able to make decisions.
- New organisations can also provide help and support to CCGs.
- A new system called monitor was introduced to ensure that competetion does not take over patient care.
- Proposals not discussed in Coalition agreement, so much was opposed by Lib Dems.
- Much opposition from the BMA.
- 'Any willing provider' can deliver services - changing key elements of the NHS leading to much greater role for private sector.
- Pressure group opposition: NHS Direct Action, 28 Degrees, UNITE.
Objections to NHS Reform
- The government has no mandate to change the NHS.
- Public are nervous for changes to be implemented - have an approval rating of 70% for the NHS.
- Hospitals may have to drop unprofitable services.
- Doctors are not happy withr reforms.
- Seen as back-door privatisation.
- Patient equality is a threat.
NHS in Recent Years
- New NHS comissioning board set up to monitor CCG spending.
- Local councils have more of a role in tackling public health problems.
- Healthwatch is being set up as a national body to enable patients to have their say about the NHS.
- NHS treatments reamin free however waiting list imes are extremely long.
- All adults have to pay for prescriptions
- Opticians and dental are no longer free
General Welfare Under New Labour
- Labour argued significant increases in tax were not the only answer to improved public services.
- New Labour sought to streamline and target welfare payments.
- Introduced means testin.
- MAJOR criticism of LAbour policy in that the gap between rich and poor has been increased with ongoing levels of poverty.
Poverty Under New Labour
- Despite New Labour's attempt to takle poverty there has always been dispute about definition of poverty.
- 1997 Labour described poverty as being 40% or ledd of the average income, a figure supported by Joseph Rowntree Foundation.
- Absolute poverty:
- Should'nt happen in Britain due to the saftey net of Welfare State.
- This number assess the number of people below the poverty line and this cannot be changed determining time or place.
- Relative Poverty:
- Attempts to link poverty to a period of time.
- How poverty changes as society becomes wealthier.
David Cameron's Big Society
Cameron has been calling for a re-assessment of welfare reforms.
This has focused on prioritizing various social problems, and the Conservatives have also argued for a division responsibility for such isssues between the state and voluntary organisations and charities.
Led to a renewed interest in ‘social justice’ and a focus on voluntary initiatives such as ‘self help’ social action projects involving voluntary sectors rather than just relying on the state.
Cameron believes there is such a ‘thing as society, it’s just not the same thing on the state,’ significant update on Thatcher’s policy.
- Phrase coined by New Labour to describe their ideologies of social security.
- New Labour committed themselves to social security but accepted that benefits should not be universal but should instead be selective and targeted at those who are most in need.
- Value of child benefits have increase dramatically since 1997.
- State now offers up to 70% of the cost of childcare to any poor parents who wishes to work.
- 2002 onwards free nursery places for all 3 year olds - 15 hours a week.
- Child benefits introduced post WW2 and were a universal benefit.
- Coalition altered these benefits to a selective benefit.
- Some argue that this policy has contradicted 2010 coalition manifesto policy of emphasising families.
- Families where at least one parent is earning more than £50000 a year will no longer recieve child benefits - introduced on 7th January 2013
Labour's Welfare to Work Programme
- Introduced minimum wage in 1998.
- Tax credits introduced in 1998.
- 15 hours free childcare - 2002.
- New deal - introduced in 1998
- Free training schemes provided by government to give necessary skills to re-enter labour market.
- Successful in the short term, however many did not return to work.
Welfare Reform Act 2013 - coalition
- Bedroom tax
- 2013 introduced for council owned property owners.
- One bedroom allowed for each adult couple and anyone over 16.
- Two children of same sex must share until 16. Opposite sex until 10.
- Housing benefits cut by 14% per week if only one spare room or by 25% if two spare rooms.
- Universal credit
- Replaces a number of benefits with one single monthly payment (merging of 6 benefits)
- Streamlines benefits system.
- Promotes economic responsibility.
- Paid monthly into bank account like a salary.
- Universal credit is managed online - more responsibility.
- Have to agree to 'claiment commitment' - looking for work.
- Benefit cap
- Total amount of benefits cut.
- Non-dependent deductions
- Over 18 in a house not in education or work claiming benefits will be expected to contirbute towards rent.
- Basic State Pensions
- 2010 reduced the number of qualifying years needed to recieve a full basic state pension.
- 39 years for women and 44 years for men reduced both to 30 years.
- Changing the contribution condidtions for basic state pensions so that it is easier for eveyone to build up some entitlement.
- State Pension Age
- Up to 5th April 2010 the state pension age is 60 for women and 65 for men. After this date womens state pensions it will slowly rise until it reaches 65 in 2020.
- Pension Act 2008
- Contains a number of provisions aimed at encouraging greater private pension saving.
- From 2012 all eligible workers, who ar enot in a good quality workplace scheme will automatically be enrolled into a qualifying workplace pension scheme.
- Pensions Act 2011
- Puts into law the changes proposed to the state pension age timetable.
- From April 2016, women's state pension age will rise faster than origianlly planned.
- It will equal mens at 65 by November 2018.
- Equal state pension age will rise from 65 to 66.
- Ageing population.
- Scandal surround private pensions has meant less people have invested in private pensions. Making them reliant on
- Economc crisis has led to mor unemployed people putting additional strain on welfare budget. This leads to more people relying on state pension that adding to their own private pensions.