Social Democracy: Healthcare in the UK

Social democracy is one of the political options within the ideological spectrum in Great Britain that aims to serve the citizenry and meet their social needs. T.H. Marshall (yr) suggested that citizens have legal, political and social rights and the human rights European Convention (1988), explains the need for social policy in Britain.

Ants (year) as social creatures express the positive perspective of organisation in achieving objectives through collective intelligence. This algorithm complements government policy issues in identifying solutions to the challenges of the human race; expecting ideal outcomes toward better living, of which health care is relevant.. The outline of this essay on Social Democratic perspective aims to examine the historical development and changes, the general impact on the development of social policy and how it has affected Social Policy on health; health care provisions and hospital care focused on paediatrics.

The socialist democracy is an ideology that advocates an egalitarian society mainly through welfare system by progressive taxation. The core of social democracy is redistribution of the wealth of the nation by making responsible provisions for the needs of the people especially the less privileged. This attitude originated from the Fabians’ beliefs in the period of as advocated by such writers as. An identification with the opinion that exploitation of the working class has made and contributed to their poor background and position relative to their services by way of labour, some classes had benefited from their situations and reasonably a relief of such plights would make for a fair society as argued by Titmuss (1974) and Crosland (1965). Expertise for administering such services through paternalistic and elitist ideas would be welcome; this delivered the welfare system re: Beveridge report (1942). Reformation was preferred to revolutionary approach of the radical Marxists to promote peace and stability.

Capitalism as practised by the New Right perhaps produced negative impact within the society of which inequality is one of such weaknesses and in order to stop its widening gap a socialist democratic government needed to intervene. The above underscores the elitist thinking in the 20th century and the bedrock to the influence and development of Social Democracy in Britain and subsequently to the works of Sir William Beveridge and John M.Keynes. Sir William Beveridge aruged in his report the aim and an objective of the Welfare System after the war, was to defeat the ‘five giants’ which were the bane of the society; disease to be eradicated by the creation of the NHS, Squalor-housing scheme through local authority, idleness-creation of employment, ignorance-an educational system and want-provision of social security system. Funding was by compulsory national insurance contributions into a common purse and from which people social needs could be met. John Maynard Keynes an economist provided the economic theory that bankrolled the welfare system contrary opinion challenged his full employment reality and vision, which has never materialised. The first health system with three health care principles, firstly meeting every ones medical needs, free at point of service and based on need rather than ability to pay. Health care included; Hospital care-distinguished into; acute which covers full range of medical specialties and long stay which includes psychiatric care and nursing care whilst primary care covers hospital care which include basic medical treatment and non hospital care, also related medical professions like dentistry, optics and pharmacy the third aspect involves domiciliary health care (home nursing). Public health -includes preventive medicine and conventional health services like housing, water supply sewerage and food hygiene. The National Health Service Act 1946 legally created the NHS which took effect from 5th July, 1948 with Aneurin Bevan as the Health Minister under Prime Minister Clement Attlee of the Labour party. ( this needs to come

The Emergency Medical Services (EMS) employed doctors and nurses during the war to care and cater for the injured which encouraged building up of the national services but considerable opposition came from the British Medical Association (BMA) concerning GPs working for state health centres. The pretext, David Lloyd George introduced the national Insurance act in 1911 which catered for the medical care of the worker excluding his family members, an option favoured by the BMA for commercial gain. The church, community and the voluntary sector involvement had earlier through charity supported the disadvantaged and less privileged citizens in meeting medical care.

The NHS developed under reforms when by 1956 the financial strain on the NHS started to show which facilitated charges for prescriptions and the growth and development demanded reforms and restructuring of the institution. Internal Markets and NHS Trusts encouraged competition. Further reformations saw the strengthening of the internal market introduced by Thatcher by the Blair government as a result of rising costs of medical technology and medicines in addition to the demand of an ageing population socially aware of the benefits of health care delivery and the impact on quality of life.

Outsourcing of medical services, fund holding ,choose and book, governance, staff, budgeting and I.T. innovation(NPfIT) which is claimed to be the biggest single project and estimated for £30billion is an overrun of both budget and time frame, these are just are few of ongoing plans and reforms within the mega -NHS. The neo-liberal economic approach of internal markets was unavoidable in view of the spiralling budget of the NHS but still maintain the social democratic values of sustaining the growth and development of the health care system.

Most hospitals prior to 1948 had been damaged by the wars e. g .; St. George and Paddington hospitals were in a bad state of repairs and lacked diagnostic facilities, pathology and radiology and operating theatres. About 16000 were dying of rheumatic heart disease and 5000 new cases among children and adolescents yearly. Diagnosis, prognosis and treatment depended on availability of bed and were admitted at an advanced stage of their disease due also to inexperience and limited facilities. Mental hospitals could not cope with the number of the mentally ill and or handicapped. NHS birth assimilated 1143 voluntary hospitals with a total of 90000 beds and1545 municipal hospitals and 390000 beds. It became apparent to develop specialist services accessible by the populace that led to the establishment of 12 teaching hospitals and special hospitals like Great Ormond Street. Research and development became necessary and this had an impact on the work of the NHS and contributed significantly to the success of treatments as aided by improved training of medical staff, Post Graduate Medical School at the Hammersmith Hospital influenced scientific research and a host of other pragmatic factors. In addition, investments were made for new infrastructures and hospital buildings to modernise the NHS. Great Ormond Street Children Hospital e.g. has experienced tremendous changes after 1948, one of which is the provision of specialist services as a national paediatric hospital.

Social democracy has evolved in contending with contemporary issues of economy, equality, social justice, political economy and others that have shaped and revised its ideology in recent times especially the Labour Party which has shifted to centrist left and neo-liberalistic economic style. It redefined the relationship between the state and the people therefore, according to Althusser (1970); to structure the society and become a controlling symbol but critiques like Bailey and Brakes (1979) highlighted the need to challenge the oppression through community empowerment. Beveridge and Keynes reforms have been criticised as a smokescreen (masking) to the real obstacles of social functionalism, discrimination and racism prevalent in the society which required attention. Why health policy? Britain engaged in the Boer war of 1899 to 1902 which evidenced the state of health of the citizens as a third of the recruits were unfit and there was need for the state to intervene and improve the nation’s health.

The paradox is represented by sending men to war exposed them to risks of death or casualty whereas, improving healthcare increases life span through better quality of life, presumably the art of governance requires painstaking decision- making striking a right logical-balance(this needs to be supported by a theory or empirical evidence). Because out of the debris and ruins of the world wars came the birth of the NHS, one of the most ambitious political and social human creations ‘from cradle to grave’ in the words of G. Rivett . The post-war period raised the important policy issue of how to respond to the issues of health? The policies appropriate to the right physical and mental wellbeing that guarantees functionality of an individual and determines the quality of life they live as discussed in the functionalist approaches of Spencer (1897). Healthy life however is dependent on a number of factors amongst which is the standard of living besides genetic make-up. Chadwick believed in the 19th century poor health was traceable mainly to pauperism to which he responded by improving sanitation. Often there are major inequalities in access to health care relative to social-class, Tudor Hart (year) referred to as ‘inverse case law’; that people in the worst health receive the least services. The above identifies why there was need for a social health policy in Britain.

The policy had a number of impacts during the last hundred years from the Beveridge report, the National Assistance Act 1947, 1950 Mental Health Act, 1970 Chronically Sick and Disabled Act up to the new right Freeman (1970) monetarist approach to the purchase of case in the emergence of the ; Mental Health Act 1983-which made changes in periods of admission and rights to challenge assessments and the way of community care. The Community Care Act 1990 affected changes that altered the arrangement between assessor and the purchaser referred to as care program approach and based on Hayek (1949) and Griffiths (1988) in introduced the notion of a cost effective approach to social democracy. Hospitals were decentralised and the market concept was introduced. Public services increased with provisions to access counselling and physiotherapy. The Community Care Act 1990 effected radical changes in social policy and health that altered arrangement between assessor and the purchaser referred to as Care Program Approach.

The Care Program Approach of 1991 introduced the privitisatiion of state services with increases in taxes and a review of benefits and access to resources that relate to causes of mental illness. Research (by who) and improved diagnostic system assisted global cross ferlization of ideas. Development of information technology and infrastructures increased to meet medical demand as well as creation of employment for health related personnel which assisted career and education feeder programmes as introduced by the Griffiths Report of (1988) Partnership with private and voluntary organisations evolved and anti-smoking and smoking cessation policies were introduced as well as healthy living and obesity concerns.

Presently as part of NHS, specialist services are provided to all without any charges apart from foreign patients. As part of emotional support for the parents of children hospitalised, free accommodations are offered as required. Services provided include heart surgery with a centre which was opened in 1950 and it is the largest cardiac centre and also the largest heart transplant centre for children in the world, this was impossible before 1948. Gene therapy is now available to treat immune related disorders and it is one of the three of such centres in the world. The Institute of child health which is a part of Great Ormond is a research centre for childhood illness besides the US. The vision of Dr Charles West became a reality with the opening of Great Ormond Street Hospital with just 10 beds with support from Charles Dickens, Lady Byron and Baroness’ Burdeff- Coutts (the richest woman in England, then)

Queen Victoria was the first Patron and in 1989, Diana Princess of Wales became the President of the hospital. The variety Club was opened in 1994 funded by the Wishing Well appeal, by 2002, the hospital celebrated its 150th Anniversary .its motto being ‘the child first. Its mission is to improve the health of children by being a leading centre of excellence in Europe for special paediatric services and research evaluation and education in child health. The Hospital is equipped with up-to-date diagnostic and treatment facilities and one of the very few Hospitals worldwide to provide a wide range of specialties on one site. It has about 31 departments with Harris International Patient Centre that caters for private patients whose treatments are funded by overseas governments and this is used to support the work of the NHS.

Quality of service is of the highest standard, holistic with an undertone of compassion and human kindness, offering psychological and religious support where and when desired.Great Ormond is applying to become a Foundation Trust -this is a shift in policy that will give more freedom to develop its services while within the NHS but with more financial freedom and support of local people interested in its functions, progress and growth. The significance of the highlighted development is the importance the hospital is playing in the health care system of the nation, the values and the principles identify with the socialist democratic perspective and the laudable initiative of the NHS, had the BMA alternative of commercialised healthcare system been adopted, perhaps recent developments and growth would not have seen the light of day. The NHS concept has proved that collectivism has a humane approach and its union with the Keynesian economy of investment has a colossal capacity to meeting the healthcare demand of the nation.

In conclusion, collaboration not competition which is individualistic and exploitative symbol of neo-liberalism capitalist approach could have denied the experience of improved quality of life as well as the increased life span of this generation, not to mention the public awareness and the positive benefits of a free health care system, cannot be compared with any other in this generation ‘our eureka’.

The Social Democratic perspective from which the Labour Party evolved has imbibed few neo-liberal approaches to compliment the many achievements the institution of the NHS has made despite its shortcomings. A threefold cord of ethical legacy created by democratic power, and being maintained by it (Banton,(1994) paraphrased).