Introduction

47: Social Policy for Health and Social Care

This unit will give learners an understanding of social policy and an insight into how it applies to health and social care. It will show how laws are made through the policy-making process, the structure of government and an overview of how Parliament works.

Learners will begin to understand different approaches to welfare policy and government initiatives to income inequalities. They will have an opportunity to examine the effectiveness of strategies aimed at vulnerable groups in society.

Learning outcomes:

On completion of this unit, you should:

1 Understand the structure of government and the policy-making process

2 Understand government responses to tackling social inequalities.

1  Understand the structure of government and the policy-making process 

Levels of government and their impact on policy decisionsIn the United Kingdom, Parliament is where laws are passed that govern the country. It is based at the Palace of Westminster and is the highest legis-lative authority, i.e. it has the right to make the law, including the law that has seen some powers trans-ferred (devolved) to the other countries within the UK – the Welsh Assembly Government, the Scottish Government and the Northern Ireland Assembly.

Key termLegislative authority – the right to make the law (legislation).

Structure of Parliament. Parliament actually has three parts, consisting of the Monarch (King or Queen), the House of Commons and the House of Lords. Historically, the Monarch governed the country as supreme ruler. However, over the centuries Parliament has gradually taken over the powers of the monarch and now the Queen’s formal role as head of Parliament is ceremonial only. The Queen always takes the advice of her ministers, so in practice, Parliament operates as the House of Commons and the House of Lords; this is where the government operates and new laws are passed.

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Key termPolitical party – a group of people sharing the same beliefs and values. Members are chosen by political parties to stand for election to Parliament. They will represent a constituency.

All legislation must be passed by the House of Commons to become law. Members of the Cabinet must regularly answer questions in the House of Commons put to them by Opposition Members. The political party with the second highest number of seats forms Her Majesty’s Loyal Opposition (because, whilst opposing the government, they remain loyal to the Crown). The Opposition has a Shadow Cabinet and a Leader – all elected MPs, – whose job is to scrutinise the govern-ment’s decision making on behalf of the public and particularly their constituents. You can watch questions being asked and answered on http://news.bbc.co.uk/democracylive/hi.

Questions in the House of Commons are addressed through the Speaker whose job is similar to the chairman of a committee. The Speaker controls the debates and questions in the House of Commons, sitting on a chair at the front. He or she keeps the timetable and says who may speak, as well as keeping order and discipline (you will hear the

The key functions of Parliament are:

●● to scrutinise (examine closely) government policy and administration (the way government is organised and how government ministers behave)

●● to control finance; Parliament gives permission for the government to collect taxes and decide how the money should be spent

●● to act in the public’s interests and protect the rights of individuals

●● to hear criminal and civil (non-criminal) appeals against judges’ sentencing decisions in the House of Lords, the highest court in the country.

●● to debate (discuss and argue the case for and against) key issues of both national and international importance in both Houses of Parliament.

Structure of governmentIt is important to recognise that Parliament is separate from the government (Her Majesty’s Government). Her Majesty’s Government runs the country, deciding what policies are required and presenting legislation (laws) to Parliament for debate. It consists of members of the House of Commons or the House of Lords, but usually the House of Commons.

The Cabinet is the decision-making body, consisting of the Prime Minister and between 21 and 24 Cabinet Ministers. These are the most senior government ministers appointed by the Prime Minister, and are usually in charge of government departments. They can be drawn from either the House of Commons or the House of Lords.

The Palace of Westminster© Ray Tang/Rex Features

The House of Commons consists of (currently) 646 Members of Parliament (MPs) elected through the voting system to represent their area, or constit-uency (electoral district). There are constituencies within each region; England, Scotland, Wales and Northern Ireland. A general election is called at least every five years, and all the people on the electoral register (a list of people eligible to vote) in a constituency go to their local Polling Station to cast their vote for the person they wish to be their MP and represent their interests in Parliament. The person with the most votes is elected. When the votes have all been counted nationally, the political party with the most MPs is invited by the Queen to form a government; the leader of the political party that wins most votes becomes the Prime Minister. The government consists of the Cabinet members, and backbench MPs – so called because they sit behind the Cabinet members in the House of Commons.

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Speaker cry, ‘Order, order!’ and bang their gavel if MPs get too noisy). The Speaker may punish MPs who break the rules. Government members sit on the right of the Speaker and members of the Opposition on the left. Questions have to be addressed to the Speaker and no-one can make a speech without permission from the Speaker. The Speaker is independent and does not take part in any debates.

Key termSpeaker – the person whose role it is to maintain the smooth running of Parliament and discipline MPs.

The House of Commons at work© PA Archive/Press Association Images

Government business is also scrutinised through Select Committees, which are set up to debate and examine aspects of public policy. They elect their own chairman and the composition of members is roughly in proportion to their party’s strength in the House of Commons. Select Committees collect evidence and reflect on aspects of public policy, before presenting a report on their findings to the House of Commons.

The House of Lords has two different types of members: senior bishops of the Church of England (called the Lords Spiritual), and members of the peerage (Lords Temporal). Members of the House of Lords are not elected by the people, but are nominated by the political parties, vetted by the House of Lords Appointments Commission, and appointed by the Queen on the advice of the Prime Minister.

The formal name for the House of Commons is ‘The Honourable the Commons in Parliament Assembled’. The word ‘commons’ comes from the old French ‘commune’, meaning district. When members of the House of Commons speak to each other they cannot use names and have to refer to MPs of the same political party as ‘My Honourable Friend’ and MPs of other political parties as ‘The Honourable Member for. . .’ (the name of their constituency). The Speaker is addressed as ‘Mr. Speaker’ or ‘Madam Speaker’.

Did you know... ?

The House of Lords at work © PA Archive/Press Association Images

The main job of the House of Lords is to act as a check on government by scrutinising, questioning and debating policy and other issues, and examining and revising the laws proposed in the House of Commons. Because the House of Lords has many members who were previously MPs, they have a lot of expertise, which is used within Select Committees. The House of Lords also acts as the Supreme Court of Appeal for both civil and criminal cases where there is a challenge to a judge’s sentencing.

The House of Lords also has a Speaker – the Lord Speaker, however unlike the Speaker in the House of Commons, he or she has voting rights the same as all the other Lords. The whole House maintains discipline, as they are self-governing.

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Government whips

The role of the whips is to make sure that MPs attend and vote in line with their political party to support legislation. There is a Chief Whip for each political party, a Deputy Chief Whip and a number of junior Whips. They keep the cabinet informed of the opinions of backbench MPs, acting as a go-between and keeping everyone informed of the parliamentary business such as the timetable of activities, questions, legislation due to be debated etc. The government Chief Whip’s title is ‘Parliamentary Secretary to the Treasury’ and he or she is a member of the cabinet. Whips are directly responsible to the Prime Minister.

Government departments (Ministries) are organi-sations that administer government policy in their area of responsibility on behalf of the government, for example, the Department of Health. It is their job to ensure that the policies get translated into action. Each department has a government minister, usually a cabinet member, known as the Secretary of State (e.g. Secretary of State for Health) and who is responsible for direct political oversight of the department. Their responsibil-ities are called a ‘portfolio’ and a team of junior ministers supports them.

Below are the key government departments:

●● Department of Foreign and Commonwealth Affairs

●● Treasury Department●● Justice Department●● Home Department●● Department of Defence●● Department for Energy and Climate Change●● Department of Health ●● Department of Education●● Department of Transport●● Department for Communities and Local

Government

The name ‘Whip’ comes from foxhunting? It was the name given to the person riding at the back of the hunt who had the job of cracking the whip to keep straying foxhounds in line!

Did you know... ?

●● Department of Environment, Food and Rural Affairs

●● Department for International Development ●● Department of Culture, Media and Sport (and

Olympics at the time of writing).

All of these departments have a Secretary of State who is a cabinet member. In addition, there are Secretaries of State for the devolved governments; the Secretary of State for Scotland, Wales and Northern Ireland respectively.

There are also some non-ministerial government departments, which are less important and do not need direct political oversight. Sometimes governments will change the areas of responsi-bility that the departments have and re-name them; for example, the Department of Health was at one time called the Department of Health and Social Services, and the Department of Education was called the Department for Children, Schools and Families.

The role of the civil service The civil service is the name given to the collection of people and organisations, which, whilst remaining politically neutral, help the government develop and deliver policies and services. Some parts of the civil service work in the Ministries and are called Permanent Secretaries; they are supported by their juniors called Private Secretaries.

The Permanent Secretary supports the Secretary of State and, because they are not aligned to any political party, they remain with their allocated Ministry. Secretaries of State, being members of the cabinet, are only there for as long as the government is in power, or as long as the Prime Minister wants them to be. The Prime Minister can ‘re-shuffle’ the government under certain circum-stances and move ministers from one department to another. The way this arrangement works in practice was the subject of a popular comedy satire called ‘Yes, Minister’.

The head of the civil service is called the Cabinet Secretary and this role involves supporting the Prime Minister, as well as ensuring the effective organisation and running of the civil service. Civil servants work all over the UK, not just in Westminster, in a wide variety of public service roles, based in different organisations such as

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non-departmental government bodies (NDPBs). Government departments sponsor the NDPBs and ministers are responsible for their performance, although they do not control what they do. They include organisations such as regulatory bodies and coastguards.

The home countriesScotland, Wales and Northern Ireland have their own governments. These are often referred to as ‘the devolved administrations’ because some of the powers of central government (Westminster) have been transferred to them.

Scotland (www.scotland.gov.uk)

The Scottish Parliament has members elected by the constituencies in the eight Scottish Regions. Elections take place every four years and each region elects seven members.

The Scottish Executive is the Scottish Cabinet and is led by the First Minister. All members of the Executive are given the title ‘Minister’. Scotland has responsibility for several areas:

●● Taxation●● Criminal justice●● Health●● Education ●● Transport●● The environment●● Sport●● Culture●● Local Government.

Parliament (Westminster) retains responsibility for reserved matters – general economic policy, foreign affairs, defence, immigration, social security, welfare and employment.

Northern Ireland (www.nidirect.gov.uk)

The Northern Ireland Assembly members are called Members of the Legislative Assembly (MLAs), who make laws on transferred areas of responsibility. There are six MLAs for each constituency. The Executive is made up of members from the largest parties, headed by the First Minister and the Deputy First Minister. The responsibilities are similar to those in Scotland apart from taxation and criminal justice.

Wales (www.wales.gov.uk)

The Welsh Assembly Government (WAG) came into being following the Government of Wales Act 2006, which clarified arrangements for government in Wales. Prior to this, the Welsh Assembly Government had few powers in law.

The WAG is the Executive (Cabinet) with a First Minister, appointed by the Queen, Welsh Ministers, Deputy Welsh Ministers and Counsel General who provides legal advice. The role of the WAG is to make decisions, develop and implement policy for Wales. The National Assembly for Wales, which has 60 members, scrutinises the WAG’s decisions and policies, holding Ministers to account. The range of responsibilities is similar to Scotland.

Key termConstituency – a geographical area in the UK that is represented by one MP in the House of Commons. People living in that area are called constituents.

The European Union (www.fco.gov.uk and www.europa.eu)Britain has been a member state of the European Union (EU) since 1973 and therefore has to abide by laws made and agreed by member states. There are 27 member countries, and the EU operates like a partnership to promote the interests of Europe and member states throughout the world.

The EU has a parliament and elections are held every five years. Members of the European Parliament (MEPs) are elected by voters in the electoral areas of the member states. There are 12 electoral regions in the UK, including the home countries, and 73 MEPs.

The European Commission is the decision-making body, making laws which impact on all the citizens of the EU member states, but the European Parliament must scrutinise and agree (ratify) the laws before they are implemented (enacted).

Local government (www.local.gov.uk, www.communities.gov.uk and www.direct.gov.uk)Local government is responsible for services

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Activity 1

Using the web links and additional research, examine the structure of one UK home country government.

Make a presentation to your group explaining the structure of your chosen government and how it works – you can use any form of presentation including role-play, puppets, PowerPoint, leaflets, posters, etc.

P1

Arrangements in the home countries may vary slightly but the principles of local representation remain the same. For more information on your local area see www.upmystreet.com.

and facilities delivered in communities, such as environmental services (refuse collection and recycling), environmental health, parks, allot-ments, social housing, streets and transport, social services, police and education. They also implement legislation at local level.

The organisation of local government and the extent of responsibilities vary; they are organised into either county or district councils or unitary authorities, depending on whether they are urban or rural, with large or small populations.

●● County councils cover large areas and are responsible for most public services, e.g. education and schools, social services and public transport.

●● District or Borough councils are responsible for local planning, leisure services, refuse and recycling services.

●● Unitary authorities provide all services in most large towns and cities. The names vary and they may be described as Metropolitan District Councils, City Councils or (confusingly) County Councils, Borough Councils or District Councils.

In London, arrangements are slightly different and each of the 33 London boroughs is a unitary authority in its own right, overseen by the Greater London Authority (GLA), which includes the Mayor and the Assembly and provides government across the capital. The GLA has responsibility for transport and the policing of the capital. (see www.london.gov.uk).

Locally elected councillors run local government (councils). Each council area is divided up into a number of ‘electoral wards’ and each ward has a councillor elected for four years to represent the views of local people. They are not paid wages but can claim expenses; they make themselves available to the local people by holding ‘surgeries’ so that individuals can come and speak directly with their councillor. Responsibilities include making decisions about local services.

Local services are provided through council departments, covering an area of responsibility e.g. Children’s Services. Officials run the depart-ments, with senior members likely to belong to the executive group. The councillors decide on the policies and the paid employees implement them.

The policy-making processThe work of Parliament involves developing, debating and passing legislation into law (statute). New legislation (Primary Legislation) is set out in the Queen’s speech, traditionally presented at the start of the new session of parliament each year. This is essentially the government’s agenda for the parliamentary session; however new laws can be put before parliament from an MP or member of the House of Lords.

Not all legislation is new – sometimes laws need to be updated, perhaps because new circumstances arise that need new powers to combat a threat to the public or to national security, for example. When an Act of Parliament is changed it is known as ‘Amended’ and this usually appears in the title in brackets, e.g. Race Relations (amended) Act 2000.

Before a new law is even considered, the government needs to be made aware of an issue and decide if action needs to be taken. This will depend on the government’s priorities and its political position. Sometimes the law needs to be changed because of a ruling in the courts, whose role is to interpret and clarify the law as it applies to real cases – this is called Statute Law (see www.statutelaw.gov.uk).

Sometimes the government will become aware of an issue because it has been raised in the

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media or newspapers. For example, in cases where healthcare organisations have failed an inspection from a regulatory body in relation to a particular client group, the government has the power to protect the public by changing the law to make sure that the same circumstances do not arise again.

In other situations, the court in the UK or the EU can influence governments to change the law. One example was the ‘Bournewood’ case involving an autistic man who was kept in Bournewood hospital against the wishes of his relatives. The European Court argued that he had been unlaw-fully deprived of his liberty because he ‘lacked capacity’ to speak for himself. This resulted in the Mental Capacity Act 2005.1 The government consulted with the public, with professionals, mental health organisations and with mental health services users before drafting the new law.

In other instances, the government may commission research to check the facts and build the evidence for either taking action to develop or amend legislation or to put the case for not changing anything. In health and social care, the government regularly commissions surveys and academic studies into health issues to make sure the UK compares favourably with other similar countries in terms of the health of the popula-tions. The Office for National Statistics and the NHS Information Centre both collect statistics on health and related issues that may be used when considering new legislation, e.g. Health Impact Assessments, which are a way of identifying what impact a proposed government policy may have on health, for example energy policy. In this example, there are health benefits to providing financial support for disadvantaged groups – winter fuel payments prevent deaths from hypothermia, for example, and financial support for improved insulation helps low-income families keep warm and save money, as well as preventing waste.

Sometimes MPs will put forward proposals for new legislation – these are not in the Queen’s speech and are known as ‘Private Members’ Bills’.

1 Bournewood safeguards www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_062995

The Passage of a Bill Bills are proposals for the introduction of new laws or the changing of existing laws, which are presented to Parliament for debate. Bills most frequently start in the House of Commons, but can be started in the House of Lords and can only become an Act (a law) if both houses approve. Table 47.1 shows the process of passing a Bill.

You can find the definitions for some of the words used above, and details about this process and other elements of parliament, at www.parliament.uk/about.

Activity 2

Research the Health Act 2009. In small groups, identify the main issues the act addresses.

What factors might have triggered this legislation?

Describe how the act was developed and its passage through Parliament. You might be able to find out if there were any amendments to the act.

Do a presentation to your group, showing how the act came into being – you could do a role-play or PowerPoint presentation, for example.

P2

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Table 47.1 The process of passing a Bill

House of Commons House of Lords

First ReadingFormal Introduction●● Short title is read out, followed by an order

for the Bill to be printed. ●● No debate occurs, as the first reading is

more of a formality.●● Bill is published as a House of Commons

paper for the first time.

First ReadingFormal Introduction●● WHEN? At any time during a parliamentary

session.●● The Member of the Lords in charge of the

Bill reads out its long title, which indicates the Bill’s content.

●● Bill is printed.

Second ReadingDebate on the Bill’s Main Principles●● WHEN? Normally two weekends or more

after the first reading.●● The responsible government minister,

spokesperson, or MP opens debate, followed by a response from the official Opposition spokesperson. Then, other Opposition parties and backbench MPs join in.

●● The Commons then votes to decide whether the Bill should be allowed to advance to the next stage.

●● Sometimes MPs may agree to a Bill’s progress without debate.

Second Reading●● Debate on the Bill’s Main Principles●● WHEN? Normally two weekends or more

after the first reading.●● Before the Second Reading, a list of

speakers and the order in which they will speak is published. This is based on which Members have put their names forward.

●● The responsible government minister, spokesperson or MP opens debate. Any Member can speak, which tends to indicate which are most interested in amending the Bill or its particular clauses. These debates may last a few hours or a couple of days.

Committee StageLine-by-Line Examination of the Bill●● WHEN? Usually within two weeks of the

Second Reading. Most Government Bills are formally timetabled after a successful second reading.

●● Most Bills are dealt with in a Public Bill Committee. For Bills that start in the House of Commons, the committee can hear evidence from non-parliamentary experts and interest groups.

●● Each part (clause) and any proposed changes (amendments) are discussed. The amendments for discussion are chosen by the chairman of the committee and can only be voted on by committee members at this stage.

●● Once every clause has been agreed to, changed or removed (which may happen without debate under a programme order), amended Bills will be reprinted.

Committee StageLine-by-Line Examination of the Bill●● WHEN? Usually two weeks or more after

the Second Reading, and can last one to eight or more days, as there is no time limit on the discussion of amendments.

●● Before the Committee Stage, amendments are published in order in a Marshalled List. Those on related subjects are grouped together and a list, ‘groupings of amendments’, is published on the day.

●● Each clause of the Bill must be agreed to and amendments voted on.

●● If amendments have been made, the Bill is reprinted with these included.

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House of Commons House of Lords

Report StageChance for the Whole House to Discuss and Amend the Bill (if originated in Lords)Further Chance to Change the Bill (if originated in Commons)●● WHEN? No set time period between

Committee Stage and Report Stage.●● Bill returns to the floor of the House of

Commons for further debate, where all MPs may speak, vote, and suggest amendments or additional clauses.

Report StageChance for the Whole House to Discuss and Amend the Bill (if originated in Commons)Further Chance to Change the Bill (if originated in Lords)●● WHEN? Usually two weeks after

Committee Stage.●● Before the Report Stage, amendments

are published in order in a Marshalled List. Amendments on related subjects are grouped together and a list, ‘groupings of amendments’, is published on the day.

●● Continuation of the line-by-line examination of the Bill. Votes happen and any Member of the Lords can partake.

●● If the Bill has been amended, it is reprinted with these changes included.

Third ReadingOpportunity for Final Debate on Bill (if originated in Lords)Final Tidying Up of Bill (if originated in Commons)●● WHEN? Usually immediately after the

Report Stage, often on the same day.●● Final chance for Commons to debate

contents of Bill. Debate now focuses only on what is in the Bill, as nothing can be added or changed.

●● After the debate, the House votes on whether to approve the Third Reading.

Third ReadingOpportunity for Final Debate on Bill (if originated in Commons)Final Tidying Up of Bill (if originated in Lords)●● WHEN? Normally three sitting days after

the Report Stage.●● The day before the Third Reading,

amendments are published in order in a Marshalled List. Amendments on related subjects are grouped together and a list, ‘groupings of amendments’, is published on the day.

●● Unlike in the House of Commons, amendments can be made at this stage, as long as the issue has not been fully considered and voted on at an earlier stage.

If the Bill started in the House of Commons, it now goes to the House of Lords for its first reading there. (Refer to right-hand column.)

If the Bill started in the House of Lords, it returns there to the House of Lords for the consideration of any amendments the House of Commons has made. This stage is known as the Consideration Stage.

If the Bill started in the House of Commons, it now returns to the House of Commons for the amendments made by the House of Lords to be considered. This stage is known as the Consideration Stage.

If the Bill started in the House of Lords, it is now sent to the House of Commons for its first reading there. (Refer to left-hand column.)

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2  Understand the government responses to tackling social inequalitiesGovernments have different approaches to tackling social inequality depending on their political beliefs and persuasions. Whilst most people recognise that social inequality is undesirable, they disagree on the reasons for persistent social and health inequalities and what action govern-ments ought to take. This section provides a brief overview of key political ideologies.

Key termPolitical ideologies – describe the beliefs that underpin political approaches and actions; political belief systems.

House of Commons House of Lords

Consideration and ‘Ping Pong’●● Sometimes an act may go back and forth between the Houses – or ‘Ping Pong’ until both

Houses reach an agreement. ●● In exceptional cases, they may not reach an agreement at all and the Bill falls. ●● If certain conditions are met, though, the Commons can use the Parliament Acts to pass the

Bill in the next session, without the consent of the Lords.

Royal AssentBill Becomes an Act of Parliament

●● Royal Assent is agreement from the reigning Monarch to make the Bill into an Act of Parliament. It is a formality, but a Bill cannot be passed without it. It usually happens immediately once Consideration or Ping Pong has finished, and can take a matter of minutes.

●● When Royal Assent is given, an announcement is made by the Lord Speaker in the House of Lords, and the Speaker in the House of Commons, at an appropriate time in each House’s proceedings.

●● At Prorogation (the formal end to a parliamentary year), Black Rod interrupts the proceedings of the House of Commons and summons MPs to the Lords Chamber, where the Lords Commissioners announce Royal Assent for each Bill.

●● Once Royal Assent has been given, the legislation of the Bill in question may commence immediately, after a set period of time, or after a Commencement Order by a government minister. If there is no Commencement Order, the Act will come into force from midnight at the start of the day of the Royal Assent.

GovernmentsWe live in a representative democratic society, which means that, unlike the early-19th century when only 1 out of 3 adults was entitled to vote, any British citizen over the age of 18 years can now vote, even if they live abroad. Governments consist of elected representatives of the voters in the UK. They are made up of members of whichever political party gained the most seats in the House of Commons – each MP elected to represent their constituents gets a seat and the party with the most seats wins the election and forms a government.

UK Political partiesPolitical parties have different beliefs and values, which are informed by a range of issues including political philosophies. Individual MPs are also products of their personal upbringing and sociali-sation, including their understanding of how society should be organised and how individuals

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should benefit. MPs usually have strong views about such matters and go into politics to try and influence the course of events and improve things.

The range of political opinion can be thought of as a continuum from left wing or collectivism to right wing or individualism (for more infor-mation, see Unit 7, Collectivism and the New Right). Despite the range of political beliefs, there are only three significant political parties in the UK capable of obtaining enough support from the population as a whole to form a government – Labour, Conservatives and Liberal Democrats. This is a similar situation to that in Europe and, where one party does not command sufficient support, they may join together with one of the other parties to form a coalition government.

The main political parties currently active are as follows.

The Labour Party

This was set up in 1906 with the support of the Trades Unions and various socialist groups to represent the interests of the workers and working class. Members of the Labour Party believe in social justice and government intervention to achieve social and economic ends.

Political ideology – Social democracy (Left wing).

The Conservative Party

Originated in 1678–81, the Conservative (or Tory) party has adapted over the years, and although

Key termCoalition – a government made up of more than one political party, who have formally agreed to work together. This usually happens when no party has a majority of seats to govern overall.

The terms ‘Right wing’ and ‘Left wing’ originally referred to the seating arrangements in the French Parliament during the 18th century?

Did you know... ?

some of the original values and beliefs remain – such as a belief in traditional values – they have adopted a much more neoliberal approach, particularly to welfare, in the last 40 years.

Political ideology – Liberal conservative (Right wing).

The Liberal Democrats

This party was formed in 1988 through a merger between the Liberal Party, with a long historical tradition, and the Social Democratic Party. This effectively modified their beliefs. They believe in social justice and the welfare state.

Political ideology – Social liberalism.

Other political parties

There are a number of other political parties who are either specific to the UK nations, e.g. the Democratic Unionist Party, Sinn Fein and the Social Democratic and Labour Party (Northern Ireland); Plaid Cymru (Wales); and the Scottish National Party (Scotland), or are seen as primarily single-issue parties, e.g. the United Kingdom Independence Party (UKIP), whose key aim is withdrawal from the EU; Veritas, which campaigns against immigration; and the British National Party (BNP), which aims to keep the ethnic profile of the UK as white Anglo Saxon. The Green Party campaigns on environ-mental issues and how this affects economic and social justice. There is also an ‘independent’ category, which allows people who do not belong to a particular political party to campaign, some of whom have won seats in Parliament.

Below in Table 47.2 are listed some of the ideas, beliefs and concepts that inform the main political parties.

Key termsWelfare – action, usually by government, to improve the social, financial and basic well-being of people most in need.Political beliefs – known as ideology, these often form the basis of policy and legislation.Laissez-faire – means to leave alone, not interfere. In politics, it means minimal regulation by government and minimal social welfare (government or state help for those in poverty/need).

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Table 47.2 The ideas, beliefs and concepts that inform the main political parties

Left-wing political ideology Right-wing political ideology

Communism – radical belief in a system of collective ownership of the means of production by the workers, a free society in which all are equal and decisions are taken democratically (equal participation and equal say). ‘From each according to his ability to each according to his need’ (Communist Manifesto). Belief that political revolution is necessary to achieve communist ends.

Socialism – a belief in public ownership and cooperative management of the means of production and the allocation of resources for the benefit of all.

Both communism and socialism are collectivist – they believe in government for the welfare of the community, i.e. government by the people for the people.

Social democracy – belief that socialism can be achieved gradually through reform of capitalism whilst keeping the ethical ideals of collectivism.

Democratic socialism – all forms of socialism that take an evolutionary and reformist approach to achieving socialist ideals rather than revolution.

Social liberalism – a belief that liberalism should include social justice as a legitimate aim of government. A belief that the welfare of the community and the freedom of the individual are not mutually exclusive.

Capitalism – an economic system in which the means of production are privately owned. Private decisions determine supply and demand, prices and wages. Profit is distributed to the owners and shareholders.

Classical liberalism – belief in the freedom of individuals, free markets, and limited government (laissez-faire).

Neoliberalism – the application of classical liberal principles, believing that commercial principles should determine economic and social policy and that welfare should be commodified and subjected to market forces of supply and demand and consumer choice.

Economic liberalism – belief that political, social and economic freedom are inseparable. Opposes government intervention in the free market and uses the idea of liberty to justify freedom from economic regulation.

Both capitalism and neoliberalism focus on individuals and individual freedoms with minimal government interference.

Conservatism – belief in tradition and preservation, emphasising stability and continuity.

Social conservatism – a belief that traditional values and behaviours, e.g. marriage, can be encouraged or enforced by governments on the basis that they keep people civilised and well behaved.

Liberal conservatism (the New Right) – combines the key principles of economic liberalism with traditional conservative and neo-liberal values.

The Third Way – aims to bridge the left/right divide by adopting right-wing economic approaches to capitalism and left-wing social welfare policies. Seen as a centrist position.

13Unit 47: Social Policy for Health and Social Care

Government responses to tackling social inequalitiesBecause social inequality is closely linked to health inequality, the approach taken by governments to tackling this depends on their political ideology and how this informs their view on particular issues. It is useful to have a look at the origins of welfare because some approaches to modern welfare have historical roots.

Social welfare has its origins in the development of the Poor Laws, the first of which emerged in the 1300s, influenced by the dissolution of the monas-teries that had provided food and shelter for the homeless and destitute and care for the sick. The Poor Laws allowed local parishes to collect money from their population to provide ‘relief ’ – food and shelter – for the old, sick, disabled and needy, although those who were fit enough had to work to earn relief (so called because it ‘relieved’ the suffering of the poor).

A new Poor Law was introduced in 1601, which limited relief to the poor of the particular parish (local area) so if you became destitute you had to travel back to your own parish to obtain relief. It said that parents and children were responsible for each other and elderly people had to live with their children. People were treated differently, e.g. the ‘impotent’ or helpless poor were the old, sick, disabled and children, considered to be deserving of relief because their situation was not their fault. The other group were the unemployed – the able-bodied poor – who were admitted to the workhouse and given jobs and minimal pay. These

The Poor Law system was not formally abolished until the 1948 National Assistance Act (the beginning of the modern welfare state) and that some parts of the Poor Law remained (on the statute book but not used) until 1967? Many older people who remembered the Poor Law carried a small amount of money around so they were not ‘destitute’. They were scared to go into hospital, as many hospitals had been former workhouses.

Did you know... ?

were the undeserving poor, who were thought to be responsible for their own poverty by not working.

Conditions in the workhouses were deliberately bad as they were intended to be a deterrent to the undeserving (Poor Law Amendment Act 1834) – the idea behind less eligibility was that conditions in the workhouse should be worse than that of the poorest free labourer so that people would not want to go in.

There have been several influential reports on health inequalities, e.g. the Black Report,2 which concluded that material deprivation (poverty) was the biggest cause of health inequalities. The Black Report made many recommendations; however, the Conservative government of the time did not accept the findings and was not prepared to implement the recommendations, on the basis that they were too costly and unproven.

The Conservative government, which was elected in 1979 and in power until 1997, adopted neoliberal economic policies, introducing market principles into welfare services. In health and social care examples of this included:

●● Closing many of the old mental institutions and introducing ‘care in the community’, in which families were expected to take over the care of relatives released from the mental hospitals or pay for private care. This policy was influenced by a belief in traditional values and family structure, the belief that governments shouldn’t provide care that family could provide, and principles of consumer choice – care could be paid for. This policy also fit with economic ideas of small government and who should provide welfare services. Many of the old hospitals were sold to commercial developers and turned into private housing, e.g. Friern Barnet mental hospital in North London.

●● The separation of the provision of healthcare services from the purchasing of services. In practice, this introduced a ‘market’ into health and social care provision for the first time. Hospitals had to cost all their procedures, e.g. operations, and GPs and Primary Care Trusts were meant to ‘purchase’ services from those

2 See Unit 7 and Unit 12 for more details of the Black Report and legislation on health inequalities.

14 BTEC Level 3 National Health and Social Care

hospitals that offered best value for money. To do this, GPs became ‘fund-holders’ and paid for those hospital services they purchased. This was the commodification of health care.

●● Contracting out. Local Authorities (LAs) and health services had to offer contracts for certain services to outside agencies, rather than employing people directly. By contracting out hospital cleaning and catering services to agencies, nurses and other professional staff were ‘freed up’ to concentrate on their professional duties. LA environmental (rubbish collection) services were another example, with LAs having to demonstrate ‘value for money’ in all their contracts.

The Conservatives’ economic reforms involved privatising many publicly owned industries such as the railways and utilities, such as water, gas and electricity, and offering shares to the population. They were considered necessary because industry and productivity in the UK were in decline. Unemployment was rising and inflation was high.

However, the consequences of economic policies intended to resolve the situation were a rise in unemployment to over three million. Child poverty increased from 12 per cent in 1979 to a high of 27 per cent in 1992/3 (before housing costs) and at the time of writing, stands at 16.2 per cent (source: ONS).

A ‘New’ Labour government was elected 1997 and actively pursued policies intended to reduce social and, particularly, health inequalities. They stated an intention to halve child poverty by 2010 and considered that early intervention and investment in children’s services, particularly in the early years, was economically and socially beneficial. Economic benefits, for example, would follow from preventing child ill-health and any consequently reduced educational achievement, which might have led to poorer work prospects and poverty, or even crime, all of which are economic costs to society. In addition, a commitment to social justice meant that equality was regarded as an indicator of a civilised society. Policy examples included:

●● The introduction of a National Minimum Wage. This was intended to prevent exploitation of workers and keep them above the poverty line – defined by the EU as below 60 per cent of median (mid-point) earnings.

●● Introduced Working Families Tax Credits and Child Tax Credits to supplement family income where the income from work was insufficient to support the number of people dependent on it.

●● Introduced limited free nursery education for under 5s and implemented Sure Start and Children’s Centres to target health and welfare initiatives at families with young children.

●● Introduced targets for services in health and social care and education to improve performance. This was aligned with National Service Frameworks for health and National Minimum Standards for care. In education, achievement at GCSE was seen as an outcome measure of success.

The Labour government also recognised the multiple factors that contribute to social and health inequalities and set up initiatives that cut across traditional government department bound-aries. One example of this was the Social Exclusion Unit, which closed in 2006, but its responsi-bilities were transferred to a Social Exclusion Task Force to ensure that cross-departmental initiatives continued to support people in need. Initiatives included neighbourhood renewal and involved LAs much more in delivering social and health benefits – well-being – in their local neighbourhoods. LAs worked with health and education departments to tackle social problems such as rates of teenage pregnancy, which have been shown to contribute to poverty by limiting life chances of young women in particular.

The example of teenage pregnancy illustrates the difference between the Conservatives’ approach and that of Labour. Conservatives see teenage pregnancy as a threat to family stability and social order and tend to hold individual young people, especially women, and their families responsible. Labour’s approach sees teenage pregnancy as a consequence of a lack of education and social inequality because a higher percentage of teen pregnancies are in lower income groups.

The two main parties also have different attitudes to poverty, particularly unemployment. Labour believes that full employment is something to aim for, whilst recognising that in a capitalist society it is hard to achieve. Conservatives believe that unemployment, or the threat of unemployment,

15Unit 47: Social Policy for Health and Social Care

is economically beneficial because it keeps wages and wage inflation down.

LegislationMuch legislation has focused on improving school performance, recognising that wider social issues can affect the educational attainment of some children, e.g. the introduction of learning mentors, literacy and numeracy hours, and free school meals.

Other initiatives have been aimed at helping people – especially young people – to train for and obtain work, e.g. apprenticeships, Connexions.

Some legislation has been targeted at low-income groups, e.g. winter fuel allowances and free bus passes for older people, financial support for families.

At the same time there was a drive by the Labour government to reduce anti-social behaviour and substance abuse among young people, e.g. the introduction of Anti-Social Behaviour Orders (ASBOs).

In health and social care, initiatives have been aimed at shifting the focus from treatment to prevention and driving up standards, together with public health initiatives to encourage healthy behaviours and reduce health inequalities, e.g. standards for school meals and free school meals.

Acts you might wish to look at to see how legis-lation can tackle social inequalities include the Child Poverty Act 2010, the Co-operative and Community Benefit Societies and Credit Unions Act 2010 and the Equality Act 2010.

Influence of pressure groupsPressure groups can be formal or informal groups or influential individuals. For example, Jamie Oliver, a famous and successful chef, became concerned about the quality of school meals following the birth of his own children. He successfully campaigned to have freshly cooked, healthy food provided in schools.

Charities and voluntary organisations regularly commission research and aim to get as much publicity as possible from the media to support their efforts to influence governments on behalf of the groups they represent, e.g. Child Poverty Action Group, Shelter, the Low Pay Unit, Age Concern and the Alzheimer’s Society. Governments will often act if they can be persuaded that it is cost effective to do so, since social and health inequalities are economically costly, not just in unemployment and productivity, but in dealing with the social consequences, ranging from petty crime and anti-social behaviour to the cost of ill health to the NHS, e.g. heart by-pass operations.

The media can also be highly influential in influ-encing government policy, however this is limited when media organisations align themselves to a particular political ideology and their reporting lacks objectivity.

Activity 3

Using research, identify two recent government initiatives aimed at tackling inequality. Put together a presentation using mixed media to say what the issue was, how it was identified, which individuals or groups influenced the government’s response and what the likely outcome will be, evaluating the effectiveness of the initiative.

You may need to look at initiatives delivered within the last three years to be able to evaluate the effectiveness of them.

P3 P4 M1 M2 D1

16 BTEC Level 3 National Health and Social Care

Assessment and grading criteriaIn order to pass this unit, the evidence that the learner presents for assessment needs to

demonstrate that they can meet all the learning outcomes for the unit. The assessment criteria for a pass grade describe the level of achievement required to pass this unit.

To achieve a pass grade the evidence must show that the learner is able to:

To achieve a merit grade the evidence must show that, in addition to the pass criteria, the learner is able to:

To achieve a distinction grade the evidence must show that, in addition to the pass and merit criteria, the learner is able to:

P1 explain the structure of government relevant to home country

P2 explain the policy-making process

P3 explain recent attempts by the government to tackle social inequalities

M1 discuss two recent examples of current government attempts to tackle social inequalities

D1 evaluate the effectiveness of two recent examples of current government attempts to tackling social inequalities

P4 explain how pressure groups have recently attempted to influence policy-making decisions in relation to social inequalities

M2 assess how pressure groups have recently influenced policy- making decisions in relation to social inequalities

SummarySocial policy is about the politics of welfare. The impact of government initiatives to deal with social and health inequalities depends on the government’s political aims and ideology. Historical influences are evident in many of the beliefs about inequality and the values that stem from this.

As we have seen in this chapter, whilst ideology is highly influential, in practice governments tend to do what is required to support the economy and protect the public according to their spending priorities. In a capitalist society the underlying principles of capitalism mean that it is unlikely that social inequality will be eradicated, however governments can minimise the impact on society.

17Unit 47: Social Policy for Health and Social Care

R. Wilson and K. Pickett (2009) The Spirit Level: Why more equal societies almost always do better. Harmondsworth: Penguin.

Resources

www.scotland.gov.uk:The Scottish Governmentwww.wales.gov.uk:The Welsh Assembly Governmentwww.nidirect.gov.uk:Northern Ireland Government Serviceswww.statutelaw.gov.uk:The UK Statute Law Databasewww.upmystreet.com:UpMyStreet websitewww.london.gov.uk:Greater London Authority

www.local.gov.uk:Local Government Groupwww.communities.gov.uk:Communities and Local Governmentwww.direct.gov.uk:The public services websitewww.fco.gov.uk:The Foreign and Commonwealth Officewww.europa.eu:The European Union websitewww.parliament.uk/about:About the UK Parliament

WeblinksWL