National Health Services and Welfare State - Case Study Example

Reading Header: NHS AND WELFARE NHS and Welfare May 20, 2009 Creation of NHS and its Contribution to Development of Welfare State National Health Services (NHS) is an England government initiative committed to provide comprehensive and free health services to all residents. It was established in 1948 following the failure of the then health provision institutions to cater for the welfare of all, thus calling for government intervention to protect the welfare of those who could not afford access to health services (Crinson, 2008, p.58). Prior to establishment of NHS, health services were provided by uncoordinated private hospitals, and local authority health services providers, which were more inclined to serving those who could afford, although some voluntary services were also offered. However, during the World War II, they were unable to cope with the soaring number of casualties forcing the government to intervene and control the situation through establishment of Emergency Hospital Services (EHS) to act as a coordinating body in health services provision. Services were so discriminative with the children, women and disabled marginalized with little or no access to medical care. The adversaries of the war provoked the government to initiate creation of welfare state and legislation on health care that would ensure comprehensive services were provided by the state. This need for comprehensive health services led to the establishment of the NHS under the Ministry of Health. The formation of NHS was based on three major principles; provision of universal health care to everyone, free at the point of delivery and based on clinical need and not the ability to pay (Walsh, Stephens & Moore, 2000, p.47). However, although a small charge was later introduced by the government to complement for the huge financial requirement in running NHS, the benefits realized by the citizens can not be gainsaid and indeed NHS is one of the main contributors top the creation of the welfare state. Before the formation of NHS, health services were provided by private practitioners, local government and voluntary healthcare providers. According to Crinson (2008, p.59) the provision of health services for the underprivileged was through the local authorities under the relief for the poor program. However, this initiative had been hampered by discrimination and harsh eligibility criteria that meant working for the relief and such a relief was supposed to be below the living standards of those in employment. The establishment of the Ministry of Health in 1919 brought some relief by establishing public health services, although this did not provide amicable solution. The private hospitals denied the poor access to their services despite accessing voluntary donations for health care. However, the employed population was privileged to access healthcare thanks to the presence of the National Health Insurance scheme. All these healthcare bodies experienced substantial financial strain during the 1930s financial crisis, thus necessitating the idea of welfare state. Under the principle of universal healthcare for all, NHS saw the need to equate all people by providing the health services without discrimination. This means that everyone regardless of his/her background or affiliation has an equal chance to access the services. In addition, the health services provided are of high quality that meets the needs of everyone who gets access to them. The government had to amass resources to ensure adequate health services were advanced to all, with understanding that health was a vital ingredient of a person's life. In providing universal healthcare, the aim of NHS was to ensure both men and women, children and adult, and everyone with whatever health related need has access to health service. NHS was founded to provide free healthcare to all and especially to protect the welfare of those who could not afford paid health services. This means that one had to walk in a hospital and get treated without paying anything. The pre-NHS had witnessed many poor people being shunned by the health service providers making their access for healthcare a problem. According to Walsh, Stephens & Moore (2000, p.167), the free services of this NHS were funded through the general taxation and the National Health Insurance. In the subsequent years since its inception, NHS realized that free healthcare provision was a very expensive affair and thus introduced a small prescription fee that was affordable to everyone. However, compared to the benefit derived from the work of NHS, this fee was insignificant. The third principle provides that the health services be afforded to the patient on the basis of his/her needs and not the ability pay. According to Walsh, Stephens & Moore (2000, p.79), the pre-NHS healthcare was for those who could afford but not those who needed the services thus leaving the poor out of medical care. In the contrary, NHS requires that the benefit for health care is supposed to go to those who need the services but not those who can afford to pay for the services. Crinson (2008, p.144) points out that the patients should be given equal chance to access the universal quality services based on their clinical needs and not the ability pay. This will ensure equity in provision of health care services. Over the years, NHS has endeavored to strengthen its mandate by establishing more principles that reinforce its original principles. NHS has committed itself in Provision of a wide range of services including primary and community healthcare as well as advisory services, rehabilitation and preventive medical services. This is aimed at ensuring that the welfare of all patients is catered for comprehensively. Consideration will be made on the specific needs and preferences of individuals in the community and quality services offered through elaborate procedures with efficiency and professionalism. With realization that provision of improved health care requires professionalism, NHS has taken the initiative to endeavor career development of its staff through training and promotion of education. In addition, NHS has partnered with other health sector stakeholders like government agencies, social workers, non-governmental organizations, public and private health providers and the community to ensure the needs of patients are met through efficiency in the use of public funds provided for health care. NHS understands that the general health of individuals is influenced by the various factors like environment, economic status and social affiliation and therefore has strived to ensure preventive measures are put in place to mitigate the occurrence of diseases. In addition, NHS will continue to be professional in confidential information of patients and will remain focused to enhancing performance through the use of modern technology and harness knowledge through scientific research. According to Walsh, Stephens & Moore, (2000, p.46) welfare state refers to the provision of welfare services to the whole population and legislation of the institutions through which these services are provided. For instance, the government has the responsibility to provided affordable universal education to all and therefore is mandated to create an environment where this education will be offered either through state institutions or subsidized private institutions. Welfare state development evolved around the same time that NHS was founded. Due to the many social problems faced during the period before the World War II the British government sought ways to address them and one of the ideas that came around was the need to have a welfare state. The social problems as identified by Beveridge - an investigator hired by government to research on ways to solve social problems - were poverty, disease, illiteracy/ignorance, poor housing and unemployment (Walsh, Stephens & Moore, 2000, p.46). The primary goal towards welfare state was to improve the living standards of all people, and due to the level of unemployment existing during that period, the social security benefit was established to ensure that each individual got some income from the government as a way of eliminating poverty. However the welfare state that would cover all the five social problems identified was not created until the Labor government took office in the 1945 election (Walsh, Stephens & Moore, 2000, p.45). It is during around this time when NHS was founded to take care of one of the five social problems, lack of proper healthcare, that welfare state took its shape. Before the creation of NHS, welfare of the people was at its worst especially given that accessibility to medical services was a tall order for most of the population who could not afford to pay the private practitioners who dominated the health care sector. In addition, lack of medical care acted as a catalyst to the other social problems in a more or less multiplier effect. For instance, the sick person could not be able to work which means that he/she could not earn income to feed him/herself, could not afford good housing and also led to lost opportunity for education. The post war social welfare for the people meant that everyone in the community would access the state-run services with equity. The government's strategy to create NHS and provide full employment worked well, that welfare state flourished bringing with it the social development and satisfaction. NHS principle of universal free health services to all was a major boost to welfare state because it eliminated the hitherto perceived scarcity of services and the discrimination that engulfed the pre-NHS period. For instance, there is an assurance of availability of wide range of services at no cost, although of late it is at a low cost, thus creating confidence and boosting the lives of the people at large. In the later years of the twentieth century, the government had the notion that intervention in providing welfare state had created welfare dependency, and wanted to roll back some of the services or welfare state but due to its impact in the welfare of the people, NHS was not affected; instead it was strengthened through reorganization to be more efficient in provision of its services (Walsh, Stephens & Moore, 2000, p.53). The restructuring also ensured that the individual clinical needs of the members of the society were met. The initial goal of NHS was to eradicate or reduce diseases and provide public health to all for free. Over the years, the work of NHS has borne fruit with avoidable diseases and illnesses put to their minimum and reducing disease related mortality rates to as low as possible. In addition, NHS strived to introduce measures aimed at preventing the occurrence of illnesses through conducting research and implementing the measures for the welfare of the society. The notion of free at point of delivery seems to have played a key role in enhancing the welfare of the people in that, public health is one of the most sought after services by many people and with government funding the services, then there will be unlimited supply for the services at any particular time. Even after the government attempted to cut back spending on welfare state; NHS was spared in recognition of its contribution to the society. However, during this time of 1980s, NHS had started loosing ground to private health care primarily based on quality, and freedom of choice. Therefore the need for restructuring came up in order to deal with the funding issue and to ensure NHS continued with its mission of providing public health. The 1980s reforms brought about the case of internal market where the responsibility of proper health care was placed on the provider to be accountable to the patient. In this case, the quality of health care provided should meet the needs of the patient and the patient has the opportunity to choose a service provider based on the utility derived. The internal market system was organized through creation of NHS trusts that operated in a more competitive way thus ensuring quality of services as they competed for customers. The importance of NHS on the provision of affordable healthcare for all based on clinical needs has benefited the disabled in the society by eliminating the issue of marginalization. According to Thompson and Mathias (1998, p.43), instead of creating segregated disability services for those with learning disability, they should be accorded the opportunity to access the general medical services. This means that they have a wide range of choice on where to get services without having to be restricted to specific health facilities only. This provides a level playing ground in the area of health care and boosting the welfare of the people, a total contrast to the pre-NHS period when the disabled had difficulties accessing medical care. The significance of NHS since its inception remains one of the major ingredient in the development of welfare state. Based on its principles, NHS has over the years created an element of hope in life for many who have been able to access medical services they could otherwise have been able to access. Government funding on the welfare state has ensured that all the five social problems have been reduced significantly, if not defeated. The increased government spending saw major reforms in the welfare state with privatization of major services being the norm, but NHS was spared but had to undergo restructuring with some fee introduced for prescription and selected medical services like dental and optical care services. The later governments have engineered to make major reforms with introduction of patient-led NHS where the patient has to make a choice where to get clinical needs and internal markets. All these changes are made to align health service provision with the changing demands in the world of healthcare while still endeavoring to retain the mission of NHS. References Crinson, L 2008, Health Policy: A Critical Perspective, SAGE Publications, Newcastle. 'NHS Core Principles' n.d, About NHS, viewed 20 May 2009, http://www.nhs.uk/nhsengland/aboutnhs/pages/NHSCorePrinciples.aspx/. Sullivan, M 1996, The Development of the British Welfare State, Prentice Hall, NJ. Thompson, T and Mathias, P 1998, Standards and Learning Disability, 2nd Edition, Elsevier Health Sciences. Walsh, M, Stephens, P and Moore, S 2000, Social Policy & Welfare, Nelson Thornes, Cheltenham. Read More