This essay aims to provide a critical discussion on how the influence of political ideology, public opinion, and economic factors had on major stages that the UK health and social care policy passed since the Beveridge Report published in 1942. The writer surveys the literature that documents significant events of the health and social care policies. Furthermore, the four significant changes that took place during the following periods itemized in the Beveridge Report will be discussed. The Conservative-led governments of 1942-1979 and Conservative-led governments of 1979 to 1997 followed by the New Labour government's 1997 to 2010 also influenced health and social developments. The coalition government between the Conservatives and the Liberal Democrats from the years 2010 to 2015 contributed to changes as well, and after 2015 it was the Conservatives until the present. These developments continued even to the present establishment.
Tracing the route of health and social care policy developments in the last 77 years invariably brings to the fore, agendas, and preferences of left-wing and right-wing governments in the UK as these indeed informed and influenced the choices made and the significant steps that were taken. Left-wing ideology is liberal in nature and believes that access to healthcare is among the fundamental rights of every citizen as such, it advocates deeper involvement of the government in making healthcare affordable and accessible to every citizen (Diffen, 2019). On the other hand, Right-wing ideology is Conservative and generally opposes government-provided universal healthcare in preference to private sector-provided healthcare with minimum government involvement (Diffen, 2019). So, these ideologies have shaped the contours of health and social care policy over the years. When the need to reduce public expenditure arose, right-wing governments understandably saw this as an opportunity to reduce the state influences in the provision of services and by extension, funding.
The Conservative government was led by Sir Winston Churchill who lost to the Labour party in 1945 with the latter constituting an overall majority. The atmosphere was understandably conducive to social reform owing to the pro-socialist political ideology supported by the Left-wing government. It assumed power and the five giants highlighted in the Beveridge Report were thus confronted head-on: want, disease, squalor, ignorance, and idleness (Davies, 2011). At the policy and legislative levels, the government responded by enacting the Social Insurance and Allied Purposes and the Education Acts, 1942 and responding to a White Paper on the National Health of 1944, free health services at government hospitals were introduced, free housing to the unemployed along with free primary and secondary education.
The social policy consists of various procedures employed by governments in their endeavors to provide welfare and social protection involving but not limited to health, housing, education maintenance of income, and social work (Spiker, 2004). Alcock and May (2014) describe the social policy as objectives grouped with an action plan for a community for the provision of services by the government for the needs of the people. Policy development can and should involve different sectors of society as is espoused in the philosophy of institutional model of policymaking which believes that some institutions in the nation are competent to determine critical objectives of public policy and processes (PUBLICADMINISTRATIONTHEONE, 2012). As it has alluded to earlier, policy development is primarily shaped by the political ideology of the government of the day. Political ideology is defined as the basis upon which social representations of groups are founded, and it involves any mental image that is socially shared (Van Dijk, 2002). Ideologies are systems of beliefs that are shared by social group members and such groups share other ideas which include but are not limited to knowledge and attitudes (Van Dijk, 2002). Such beliefs influence how political groups or parties respond to social and or economic issues along with perceptions of the government's role in support of its people. Denzau and North (2000) add that political ideology involves a framework of shared mental models that are set to interpret the environment and its areas under their influence. So, the ideological inclination of a government, whether left or right exerts a significant impact on the direction of policy formulation along with its provisions.
As the name suggests, the Mixed Economy of Welfare (MEW) entails welfare pluralism (Powell, 2019) with multiple sectors providing welfare as opposed to the state-dominated welfare provision. The following four industries constitute the most prominent sectors of MEW: public, private, voluntary, and or charitable, and the informal sector, which consists of family and friends. A casual survey of welfare literature shows an active involvement of the state from the 1940s characteristically moving in to fill the gaps. The welfare was unable to load satisfactorily, a situation that was to change with the advent of the Conservative government of 1979-1997 and the following which saw a much higher role of the private and voluntary sectors in the provision of social care. This shift from state-dominated welfare provision to MEW shows how different political ideologies shape policy directions since it is the right wing's preference for increased participation of non-government sectors in meeting the social and economic problems of citizens.
Before policies evolve into Laws, the proposed law which is referred to as a bill is tabled in parliament for debate until each house of Parliament approves it. The attaining Royal Assent then essentially becomes law or an Act and makes it primary legislation, but when an Act delegates power to a government minister to give orders or to make rules or regulations, these are regarded as secondary or subordinate legislation (Cabinet Office, 2013). Any government department with a proposed bill is required to submit it. The Parliamentary Business and Legislation Committee of the cabinet at least a year before the next session of Parliament endeavors their proposal to be tabled, the decision to accept it for discussion has much to do with the degree of relationship to political priorities of the current government (Cabinet Office, 2013). When approved it will go through the first reading in parliament followed by a second reading where actual debating takes place before it is considered to both houses for line-by-line reading by special committees composed of MPs leading to the Report stage where only amendments are discussed (Cabinet Office, 2013). The third reading in the Commons takes place immediately after the Report stage while in the Lords usually takes place on another day. Ultimately both houses should agree on the text of the Bill before it receives Royal Assent thus becoming a Law although it takes effect at least two months after the Royal Assent is given (Cabinet Office, 2013). Again, political interests of the government influence which and when a bill is tabled, and ultimately the majority (either left or right-wing) prevail on either the adoption or rejection of the proposed legislation or the degree of amendments that will be made.
The economic recessions during the early 1970s triggered by hikes in oil prices brought the issue of austerity measures into the picture and in tandem with the right-wing political ideology of the conservative governments that 1979 to 1997 The Health Service 1980 Act revoked the NHS payment of beds. It proposed that free dental and eye checks be scrapped in 1989. Furthermore, in response to the 2nd Griffiths Report on Social, and Community Care of 1988 and the White Paper on people receiving care in the community, a reduction in the mixed economy of welfare ensued with the relocation of long-term residents in live-in institutions and the closing down of some institution as a measure of cutting down the public expenditure on health again typical of right-wing political ideology. A White Paper entitled working for patients (NHS-reforms 1989), (NHS and Community Care 1990) and the (Patient's Charter 1992) spurred further right-wing ideologically inclined decisions such as the outsourcing of cleaning services, private partnership on health care with people advised to utilize private medical institutions for treatment instead of mainly relying on government-funded public health institutions. Alternative funding options were introduced, such as the Private Finance Initiative (1992) from this period new buildings built by private finance, were leased back to the NHS.
The period 1997-2010 under the Premiership of Mr. Tony Blair of the New Labour government with an unprecedented majority in parliament espoused an ideology that favored social democratic policy as they moved away from both the old labor and the neo-liberal ideologies of Thatcherism (Ham, 2009). The problems during this period were the rising costs of health care caused mainly by the aging population, an increase in life expectancy, and the treatment of chronic illnesses that required the use of new technologies (Ham, 2009). Several policy documents and white papers from 1997 to 2009 mainly on NHS reorganization and performance management on the Health & Social Care Act (2001) were either discussed or enacted to define the universal healthcare policy in the UK. The changes in the social policy mainly targeted performance and the reduction of waiting times at NHS hospitals (Ham, 2009).
The introduction of Primary Care Groups, which later became Primary Care Trusts gave doctors more power to decide on issues affecting the communities in their practices. The evidence of social health inequalities was found to be prevalent. The imbalances posed the further problem of the mixed economy of welfare (MEW) that the government had to solve. It was during this period that the patients themselves were given the autonomy to choose where they can get treatment (Ham, 2009). The tactics involved the balancing of the power of the state, and the free play of market forces allowed to operate at the local authorities was given the councils in the UK. The New Labour governments both under Tony Blair and Gordon Brown were committed to tackling the problem of widespread social inequalities through the health action zones created by the Department of Health. Again, the political, and ideological inclination is seen dictating government action and direction about meeting health and welfare problems.
The period that ensued from 2010 to the present witnessed problems of rising health and social care costs such as treating chronic illness, the use of new technologies, and the financial crisis of 2007 to 2008 posed a significant challenge with NHS England 2014 estimated a funding deficit of £30 billion forecasted for the years 2020 to 2021 (England, NHS, 2014). The election campaign of the Conservative government under David Cameroon was to reduce the government budget deficit. To respond to these challenges a coalition government between the Conservative and Liberal Democrats of different political party ideologies than a mixture of both socially liberal ideas was recognized as returning to the neoliberal, especially on austerity measures to reduce the state expenditure on social welfare (Ham, 2009). On the other hand, Deputy Prime Minister Nick Clegg promised an alternative to counteract austerity cost cuts as the Liberal Democratic partners to add civil liberties, fairness, and transparency in all political debates. The promise of the Liberal Democrat leader in government was aimed to soften the heart of their coalition partners' hard policies in government (Ham, 2009). Some of the Liberal Democrats' policies were never implemented which resulted in them being punished by the votes in the next general election by losing most of their parliament seats. There was advocacy for the reduction of the university's tuition fees. Unfortunately, the conservative from this period started to split on Brexit.
The coalition government between the Conservatives under David Cameroon as Prime Minister and the Liberal Democrats under Nick Clegg as Deputy Prime Minister published two White Papers on Equity and Excellence Liberating the NHS and Health lives, healthy people, and public health in July and November 2010 respectively. The other pieces of legislation of the Health and Social Act of 2012 and the Care Act of 2014 concentrated on the reorganization of the National Health Services and encouraged the local councils to take responsibility for people needing care in their localities with an emphasis on personal attention. The impacts on social policy brought about by these interventions included the substitution of Primary Care Trusts for Clinics that dealt with smaller units of the population to reduce the burden of management costs. A monitoring system was put in place across the health sector to improve quality this resulted in the formation of local and well-being boards within the local authorities' jurisdictions.
Health delivery by government hospitals in the UK was based on the principle of accessibility to free healthcare free for all and equity without assessing affordability to pay (Oliver and Mossialos, 2004). The NHS had to incorporate the values of efficiency, effectiveness, responsiveness to the needs of the service users, and the appropriateness of services as it became a political battle of major political parties in their election manifestos (Oliver and Mossialos, 2004). In the first phase during the 1940s, the significant change that impacted the population on the establishment of the welfare state was that the funding needs to meet with the introduction of the compulsory contribution of national insurance by all workers (Ham, 2009). The Conservative governments of 1952 made it possible through the 1949 NHS act amendment.
The third phase of change in social policy and public opinion from 1997 to 2010 was under the government's preoccupation with solving the increasing gap of inequalities in the health sector. The fourth phase of the changes in the government policies from 2010 to now was characterized more by austerity measures to cut public expenditure — the Clinical Commissioning Groups idea introduced in favor of the Primary Care Trusts that eventually replaced. There was an introduction of dialing 111 for less life-threatening conditions so that treatment can be done not at the NHS establishment but even at home. Then the usual 999 was left for more life-threatening health conditions. The emphasis was more on monitoring the quality of the services needed by users. The way to achieve the involvement of the NHS boards and they established Health and well-being boards at various local authorities. A whistle-blowing policy was initiated to have more say in patients airing their grievances through Health watch. Achievement of this, the Care Act 2014 as the new duty of the local authorities was tasked with the promotion of well-being so that people in their community do seek unnecessary medical treatment.
The essay explored the nexus at play in policy formulation influenced by political ideologies, public opinion, and economic factors. It established that policy direction in the past 77 years tended to align with the interests of either left- or right-wing governments in different phases. Where economic factors dictated severity measures as a remedy for the current crisis, it was not tricky nor surprising for right-wing governments to advocate cuts on healthcare budgets as their political, ideological orientation. It found expedient for minimum government involvement in the healthcare needs of citizens. This will be effectively and competently taken care of by players private sector, and voluntary organizations as this eased the financial burden from the government, thereby allowing resources to channel to other causes deemed necessary. When access to healthcare and social services tended to be beyond the reach of many citizens, campaigns that promised alleviation of such challenges often proved to be useful trump cards that often landed left-wing parties into the office and the policies that ensued would often have universal access to healthcare and social care at the core of government's actions. So political ideology does, in fact, crucially influence policy formulation.
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