commissioning: the acquisition or perchasing of care services of a local population of people
Eligibility criteria: the requirements or standards that must be met before a person is provided with a care service.
informal care/sector: care that is provided by relatives and friends on an unpaid basis, outside if the professional care system
independant sector: a collective term for the private and the voluntary care sectors.
private care/sector: care services that are provided to people who are willing and able to pay for them. organisations and individual practioners who sell care services in this way are collectively known as the private sector.
voluntary care/sector: care services that are provided - free of charge or for a small, subsidised fee- by non profit making organisations
the welfare state was founded in the late 1940's, this was the moment when organised, accesible and wide-ranging system of health and social care services first became available for all citizens.
the pre welfare state system provided quite limited and relatively poor quality services, and it favoured two groups - those very poor and entitled to state services and theose wealthy enough to afford services privately. before the welfare state the system provided little care or support for the majority of the population.
The main architect of the welfare state was Sir William Beveridge. he prodiced a report on social insurance and allied services now know as the Beveridge report. This identified the 5 'evils' that he believed had to be over come to improve the health and welbeing of the nation
- want - poverty
- disease - ill health
- ignorance - lack of education
- squalor - poor quality housing
- idleness - unemployment
Beveridge - NHS
Beveridge suggested the best way to tacke these problems was for the Government to develop and fund a wide range of health, social care, education, and social security services. A Nation Health Service was one of his key proposals, which was widely supported and lead to a range of health, social care and welfare services being set up across the country.
the decades to follow saw the state become the major source of funding for and the biggest provider of health and social care services that the united kingdom had ever seen.
Due to large financal increase charges for dentistry, prescriptions and glasses were introduced in the 1950's. More fundamental reforems were needed, however to contain the cost of providing comprehensive health, social care and education services.
the NHS, local governments and the education ststem all underwent successive reorganisation during the 1960s and 70s in an attempt to control the cost and make the provision of the care services more efficient.
1990's NHS Changes
the most fundamental change occured in the 1990s with the introduction of an 'internal market' in care services. the internal market involved splitting parts of the NHS and local authority social service departments into separate purchaser and provider sections. the iea was that purchasing organisations would 'shop around' ub the new care market and buy care services for a local population from the provider organisations that offered them the best value deal. in effect purchasing or commissioning bodies made contracts with the NHS trust, local authority, voluntary and private secotor provider organisations for a particular volume of care.
the Conservative government at the time believed that the internal market was a good idea because it would:
- create competition between providers
- create choice for purchasers
- cut costs, as providers tried to win contracts
- reduce inefficiency and save money
NHS changes Again!
as the internal market was a very controversial development within the care system. The new labour government who were elected in 1997, modifided it to reduce the competitive element and promote cooperation between care providers. However many of the innovations and effects it introduced still remain. In particular, the internal market in care had the effect of focusing care organisation on the costs of providing services.
the result is that tiday, although central government is still the most significant source of fundning for both health and social care services the care system now relies on private and voluntary sector care organisations and private practioners to actually deliver care services.
There are also much closer relationships between the different types of care providers, and a significant shift towards targeting care in a selective way at people who meet specific eligibility criterias