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British Social and Health Policy - from 1601

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British Social and Health Policy - from 1601 British Social and Health policy - From 1601 During the Middle Ages, support for the poor was provided in much of Europe through Christian charity. Poor vagabonds were often seen as dangerous, beggars and thieves who could spread disease. Several northern European cities introduced systems of organized poor relief, intended to limit the amount they had to pay for charity, to keep out strangers, and to control the poor. Elizabethan Acts in 1563 and 1572 made provision for the punishment of sturdy beggars and the relief of the impotent poor. 1601 The Elizabethan Poor Law was a national Act for England and Wales. (The system became law in 1597/8, but the Act that consolidated the system dates from 1601). It provided for • a compulsory poor rate • the creation of 'overseers' of relief • provision for 'setting the poor on work'. Workhouses under the Old Poor Law The 1601 Act made provision for "setting the poor on work". This did not generally include accommodation, but in 1631 there was a workhouse established in Abingdon. In 1697 the Bristol Workhouse was established by private Act of Parliament. • Malthus. - argued that population was increasing beyond the ability of the country to feed it. The Poor Law was seen as an encouragement to illegitimacy, and this would lead in turn to mass starvation. • Ricardo- 'iron law of wages' was believed to show that the Poor Law was undermining the wages of independent workers. Together with the "roundsman system", where paupers were hired out at cheap rates to local employers. • Bentham.- argued that people did what was pleasant and would not do what was unpleasant - so that if people were not to claim relief, it had to be unpleasant. This was the core of the argument for "stigmatising" relief - making it, in the happy phrase of the time, "an object of wholesome horror". 1832-1834 The Poor Law Commission emphasised two principles: • less eligibility: the position of the pauper must be 'less eligible', or less to be chosen, than that of the independent labourer. • the workhouse test: there was to be no relief outside the workhouse. Public Health Act was finally passed in 1848 Edwin Chadwick was one of the people behind the 1834 Poor Law, which first led him to investigate the issue of sanitation amongst the poor whilst he worked as secretary to the Poor Law Commissioners. His report named the ‘The Sanitary Condition of the Labouring Population of Great Britain’ was rejected by the Poor Law Commission, which did not want to be associated with it. So Edwin Chadwick went ahead and financed it’s publishing himself. He argued that the sanitation conditions in the poor parts of the country caused a strain on the remainder of the populace. The 1848 Public Health Act empowered authorities to act with no compulsion to do so. The act proved ineffective but laid the foundation for the future. It established a Central Board of Health whose job it was to improve sanitation and living standards in towns and populous areas in England and Wales. For the boards to do so, the 1848 Public Health Act put them in charge of the supply of water, sewerage, drainage, cleansing, paving, and environmental health regulation. English local government developed around the Poor Law as the authorities responsible for the services and in 1888 County Councils were formed and in1894 District Councils were formed. In the 1929 Local Government Act - The Poor Law Boards of Guardians were replaced by local authorities, which among other things transferred responsibility to the local authority hospitals, social assistance, police, fire, gas, electricity supply, water, roads, housing, education and public health. The first step in creating a nationalised health service was in 1938. The imminent war obliged the Government to establish an Emergency Medical Service. All the various types of hospitals were registered and run centrally to anticipate large numbers of expected casualties. 1942 Beveridge report- Beveridge proposed a system of National Insurance, based on three 'assumptions • Family allowances - Beveridge accepted the principle of a 'family wage', but wages could be only adequate to support a family if more was made available for families with children. However, Beveridge did not accept the principle of a minimum wage, which would also be necessary for a 'family wage' to be adequate. • A national health service - Beveridge took for granted a principle that had been obvious to administrators since Chadwick: that provision for health and unemployment had both to be made, because otherwise one set of needs would spill over into the provision made for the other. • Full employment - Mass unemployment would make the scheme unaffordable. Several measures were introduced before the foundation of the 'welfare state': • 1944 The wartime coalition government committed itself to full employment by Keynesian methods, which had been shown to work by the New Deal in the USA. • 1944 Education Act: free universal secondary education • 1945 Family Allowance Act. The Labour Government was elected later in 1945. The timing of key legislation was set to come into force on the same day, 5th July 1948 - a process which emphasised that, from that point on, everything was supposed to be different. The key measures were: • 1946 National Insurance Act • 1946 National Health Service Act. • 1948 National Assistance Act. This contained the abolition of the Poor Law, and set out a new legislative framework for provision for people in need, including residential care. • 1948 Children Act, which established local authority departments to receive children into care. July 1948 - The National Health Service (NHS) is created. May 1949 - The Nurses Act establishes a modern framework for the role of nursing within the NHS. (Rising costs give cause for concern.) April 1951 - The new Chancellor of the Exchequer, Hugh Gaitskell, proposes a one shilling (5p) prescription charge and new charges for dental treatments (chiefly dentures) and spectacles. NHS Key Dates 1946 The National health Service Act 1948 NHS begins, July 5th 1967 GP Charter – costs 80% for staff 100% for Practice 1974 Major reorganisation: "Area" tier created (Region, Area, District). Public health responsibilities transferred from Local Government to NHS 1976 RAWP begins - lasted until 1991 (RAWP applied mortality data to weighted regional populations to obtain a fair-share funding target) 1982 Area tier abolished 1984 General management introduced 1987 New payment systems for GPs to encourage more health promotion/ prevention activities 1988 Major review of the role of public health medicine 1989 "Working for Patients" describes major reforms to introduce an internal market for UK health care. "Caring for Patients" promotes community-based care 1991 Implementation of 'Working for Patient' reforms begins. "Patient's Charter" issued. "Health of the Nation" published 1992 Tomlinson Report on health care in London 1996 DHAs and FHSAs merge formally; Regional Health Authorities abolished 1998 "The new NHS: Modern-Dependable" outlines proposals for further reforms "A First Class Service: Quality in the new NHS" published, outlining a framework for improving the quality of care provided 1999 "Saving Lives; Our Healthier Nation" while paper published, the new national strategy for health. 1959 The Mental Health Act was introduced making new provision for the care and treatment of people with mental health problems. 1968 The first heart transplant in the UK took place on May 3 at the National Heart Hospital in Marylebone, London. 1972, CT scans revolutionise the way doctors examine the body 1978, the world’s first baby is born as a result of in vitro fertilisation (IVF) 1979 the first successful bone marrow transplant on a child takes place 1980s, MRI scans are introduced 1987 the world’s first liver, heart and lung transplant is carried out at Papworth Hospital 1988 breast screening is introduced for women over the age of 50 1994 the NHS Organ Donor Register is launched 1991 the first wave of new NHS trusts are established 1998 NHS Direct is launched becoming one of the largest single e-health services in the world, handling more than half a million calls each month. 2000, NHS Walk In Centres are introduced offering convenient access to a range of NHS services 2002 Primary Care Trusts were launched, overseeing 37,000 GPs, 21,000 dentists and controlling 80% of the NHS budget 2002 the 4-hour target to ensure no patient spends more than 4 hours in an A&E department from arrival to admission, transfer or discharge, is introduced 2004 Foundation trusts were first introduced. 2007 the NHS Choices website is launched 2007 1st July smoking was banned in restaurants, pubs and other public places 2008 1st April, free choice is introduced for patients 2008, 5th July the NHS celebrates its 60th birthday 2009 April The Care Quality Commission was launched to regulate the quality of services in health, mental health and adult social care. 2011, March the Department of Health published the NHS Constitution, setting out the seven guiding principles of the NHS and the rights of patients Principle 1: The NHS provides a comprehensive service available to all Principle 2: Access to NHS services is based on clinical need, not an individual’s ability to pay Principle 3: The NHS aspires to the highest standards of excellence and professionalism Principle 4: The NHS aspires to put patients at the heart of everything it does Principle 5: The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. Principle 6: The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources. Principle 7: The NHS is accountable to the public, communities and patients that it serves The NHS values are: Working together for patients; Respect and dignity; Commitment to quality of care; Compassion; Improving lives; Everyone counts.
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