1. A brief history of the UK health and social care services (1601–2015)
This is the first in a new series looking at different aspects of health and social care in the UK. I hope you find it interesting!
To fully develop a high level of understanding of health and social care practices, it is useful to begin in a historical and organisational context. Historically, care for the poor, infirm and elderly was provided through religious orders and monasteries, although following the dissolution under King Henry VIII, much of this care was removed. Almshouses, established under Queen Elizabeth I, brought together under the Poor Law Act (1601), provided some support for the neediest. By the 19th Century, these benevolent attitudes had changed. Families were expected to support their own relatives, or admitted to austere workhouses with accommodation for the destitute. As the 19th century wore on, workhouses increasingly became refuges for the elderly, infirm and sick rather than the able-bodied poor, and the Local Government Act of 1929 was passed to allow local authorities to take over workhouse infirmaries as municipal hospitals.
In addition, The National Insurance Act of 1911 introduced a pool to pay the developing family doctor service, building on the traditions of the Friendly Society. The imminent Second World War, obliged the government to establish an Emergency Medical Service in 1938. The publication of The Beveridge Report in November 1942, led to the Labour Party Government of 1945 introducing social reforms, including the establishment of a NHS in 1948, following Aneurin Bevan’s National Health Service Act 1946, outlining free medical treatment for all “from the cradle to the grave.” The NHS was built upon 3 core principles, these being: that it needs to meet the needs of everyone, that it’s free at the point of delivery and that it is based on clinical need and not on the ability to pay.
From the 1950s to 1960s, welfare spending increased dramatically and as costs continued to rise during the next two decades, a market approach began to be adopted to service provision. Since the publication of the Beveridge Report, there have been a number of Acts of Parliament relating to social care, which were brought together under the Local Authority Social Services Act 1970.
From the 1990s, the State monopoly status of the NHS and welfare provision continued to change with private enterprise encouraged to take over care provision. The NHS and Community Care Act 1990 introduced an internal market, making the state an ‘enabler’ rather than a supplier of care provision (Walsh et al. 2006).
In 1997, New Labour came into power, introducing “The Third Way” a willingness to “contemplate private and not for profit alternatives” (Dickson, BBC, 1999) to care provision, whilst trying to retain socialist views. The NHS Plan (2000) identified that “if patients are to receive the best care, then the old divisions between health and social services need to be overcome” (Section 7.1).Key legislation relating to the merging of healthcare and social care includes the Health Act 1999 and the Health and Social Care Act 2001, which formally established joint working between care services.
References:
Alcock, P. (ed) (1998): The Student’s Companion to Social Policy, Oxford, Blackwell
Crown (2000): Explanatory Notes to the Care Standards Act, London, HMSO
Crown (2002): Delivering the NHS Plan: Next Steps on Investment, Nest Steps on Reform, London, HMSO
Crown (2006): Our Health , Our Care, Our Say, London, HMSO
Department of Health (1998): Modernising Social Services, London, HMSO
Department of Health (2001): Valuing People, White Paper, London, HMSO
