The NHS – and the British Welfare State -are 75 years old today. I’m not going to try to cover all the issues here, but I did offer a potted summary in my book, How to Fix the Welfare State (Policy Press, 2022). Here are two of the summaries from that book, for the chapters on the NHS and Social Care.
The NHS
|
|
| Key points |
- The NHS offers a form of insurance, providing medical care to anyone.
- Despite the dominance of hospitals, general practice is at the heart of what the NHS does.
- The need for public health has been highlighted by recent experience.
|
| Positive developments |
- The NHS has moved away from long-stay institutions and focused on medical care.
- General practice has been greatly improved.
|
| Where policy has gone wrong |
- Private markets cannot fill the gaps. They depend on producers having choices, and that leads to exclusion.
- Health is public as well as individual. Reducing everything to the personal level compromises the aims of health services.
|
| What to do instead |
The health service has to provide different levels of service: decentralised general services, more specialised work for larger areas, and highly specialised centralised provision. |
Social care
|
|
| Key points |
- The shift from health care has left services that are fragmentary, insecure and often expensive.
- Residential care has grown because it is an effective way of providing intensive services, but not all residents need that.
- Domiciliary care has been based in a flawed model of ‘personalisation’ – and a catastrophic assumption that it won’t be sustainable.
- Care in any setting depends on continuing personal relationships.
|
| Positive developments |
- This service did not exist when the welfare state was founded.
- It was created as part of the movement away from long-stay institutions. It has its failings, but at least it has made it possible for some people to continue to live in their own homes.
|
| Where policy has gone wrong |
- Personalisation has never lived up to its promise; it only works for some.
- Creating something like a market in social care is no guarantee of choice.
- Markets offer commodities; people who need care need something different.
|
| What to do instead |
The clients of social care need people with time and skills, not a shopping list of the tasks that workers will fulfil. Both residential and domiciliary care will need teams of carers who can offer a personal service to clients. |
The NHS – and the British Welfare State -are 75 years old today. I’m not going to try to cover all the issues here, but I did offer a potted summary in my book, How to Fix the Welfare State (Policy Press, 2022). Here are two of the summaries from that book, for the chapters on the NHS and Social Care.