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Policy Making And Analysis: Case Study Community Care Assignment

Social policy usually tries to address the collective needs of groups who lack well -being or health. Social policy is a political process involving a wide array of actors, key to the policymaking arena are elected politicians who are members of the government and the cabinet. However the role of globalization and perhaps more specifically the europeanization, of British governance is becoming more evident in the policy procedure.

The provision of social services is an integrated and dynamic process. Titmuss in his inaugural lecture of 1951 suggested it was based on;

“…Services, both statutory and voluntary, with the moral values implicit in their action, with the roles and functions of the services, with their economic aspects, and with the part they play in meeting certain needs in the social process.”

This is just one of many views postulated by academics. There are many conflicting ideologies on the nature and extent of provision of social services, however a general consensus can be drawn on the key components of social services. These include social security, health, education, personal social services and housing. All of the above are essential in ensuring the nation is at the very least living at a suitable standard of living, more recently not socially excluded.

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The origins of the welfare state are often crudely attributed purely to the Social Insurance and Allied Services Act (1942). Sir William Beveridge is often refereed to as the architect who laid the blue print for the welfare state, which was implemented by the labor government. This is not strictly true as Conservatives have dominated government and in the nineteenth century paternalistic routes to maintain the social stability of society can be noted in The Representation Act (1918), which gave paupers the vote. Thus it is wrong to classify the nineteenth century, and early twentieth purely as an era of laissez faire. Conservatives did initiate change to a more collective model.

The report published by Beveridge did however lay a framework for the improved expansion and reform of social services and is one of the most influential documents in British Politics. Its core policy was universalism as opposed to pre war selectivity. Also a commitment to Keynesian economics to control and manage the British economy and ensure “equality of opportunity”. The subsequent political period is often referred to as the post war welfare consensus as there was seemingly a general acceptance from all parties that the fundamentals of the Beveridge report was a good thing and should be implemented and developed.

Background information

All of the above areas are importance and they all fit together to ensure the welfare of British citizens is met. Health is not mutually exclusive but definitely a fundamental area behind the provision of welfare. It’s origins lye in the preoccupation with generic levels of sanitation, to stop the spread of disease in the nineteenth century. In the twentieth century there was an ideological shift from preventive to curative health care, measures became patient focused due to development of science and drugs and emergence of a structured medical system. Likewise the accompanying development of social services began in the nineteenth century stemming from self-help and voluntary groups set up to help the working class from the detrimental effects of poverty.

The emergency medical service and Beveridge report 1942 were two fundamental forces behind the establishment of a National Health Service (N.H.S). The National Health Service Act of 1946 was founded on the principle of comprehensive provision of “free” services rationed on a system of clinical need. Initially funded through general taxation and national insurance system it became clear the system was going to prove expensive if it was to achieve its mission statement. Social services and care provision also progressed though through local level government as a separate entity.

During the seventies questions of an end to the post was welfare consensus stemmed from Wilson’s pay bed policy 1974-76. Doctors felt that their right to practice privately was being controlled. Harold Wilson subsequently appointed Lord Goodman to solve the problem and resulted in the formation of the Health Services Board. Their attempt to negotiate for reductions in pay beds rather than end them was met with angst from doctors and supported by the Conservatives. In 1975 shadow spokes men for Social services undermined the government and current state of the NHS.

The election of the Conservatives in 1979 resulted in an overhaul of funding, organization and delivery. This was an era of change in response to funding problems, which had developed over the last twenty-six years. In order to control the percentage of Gross Domestic Product (G.D.P.) spent on provision of a NHS new strategies were passed through the policy arena. The reigning Government of Margaret Thatcher made significant reforms finally drawing a line under the supposed post war consensus.

The Conservatives responded to problems in the NHS and social services by introducing “market forces” and business strategies. However New Right ideals such as fear of over dependency were apparent in their overhaul and the subsequent “marketisation” of the NHS. The government “rolled back the frontiers of the state” through centralization resulting from The Local Government Act and key Thatcherite strategies such as privitsaton and marketisation. Social services was reformed and controlled through local governance bodies and an internal market in the NHS due to contracting out and appointment of general managers. This resulted in a highly contested purchaser/provider split; critics believed it caused fragmentation and

management costs. There was also criticism from those more liberal thinkers who saw this marketisation undermining the egalitarian aims of a NHS.

The New Labour Government elected in 1997 implemented changes to the “internal market” whilst evidence of its social democratic roots come through in mission statements to combat the management costs and negative effects of competition, however it primarily seeks to build on conservative reform not reverse them. This is typical of Blaire’s Third Way and an effective example of his leadership style and its effects in health. The reorganization has tried to reduce competition between trusts, trusts are the key providers and primary care groups and health authorities have a purchasing role.

Community Care is a generic term used to describe a major ideological shift, de institutionalisation and the start of a new era of mental health and socil service provision. The initial measures in the 1980s were a conservative measure which being typically new right assumed the capacity of women to take a more active role in caring for their relatives.

Policy Process

There are many conflicting models of bureaucratic style which change with governments styles such as an incremental, pluralist but the central to the policy making process is the links between policy stages. No stage or actor within the system is mutually exclusive and for a policy to be implemented it must pass through the holistic model more commonly known as The Policy Making Cycle;

British Policy Networks;www.strath.ac.uk

As illustrated above the two inputs at the first stage of policy initiation are demands and resources. Demands include public reports published, such as the Griffiths Report 1998 which called for funding of community care to be local authorities responsibility. Demands do however come from a wide range of groups putting pressures and “demands” on the governments agenda. The resources needed to put policy making into action include the key actors of the procedure. This incorporates money to pay for human resources and experts such as civil servents.

The second stage of processing the inputs is a closed and rather secretive affair often referred to as the dynamics of “The Whitehall Game”, not solely dependent on officials in Whitehall but the effects of political and economic change the balance of dependence between ministers/civil servents is constantly changing. Political support weakening for example means the Prime Minister must call on the cabinet for increased support. Alternatively economic achievements means the chancellor has increased sway in the process. The core executive is not fixed and central administration is an ongoing challenge. Alliances change with debate over policy style and nature and there are no dominating figures.

The main failing of Margaret Thatcher in 1979 was loss of backbench support and underestimating the extent to which she relied on the cabinet, key actors within the core executive and resignation of Nigel Lawson did not bode well with her alliances in the executive core.

On a larger scale the European Union E.U also has an impact on British policy making since the 1970s and increasingly in the current political era where references to the europeanization of our system and other notions such as socialism via the back door highlight the contested integration of law set in Europe.

On a Transnational scale we see that views held by the largely middle class driven British Medical Association exemplified by the World Health Organization who sets the agenda on all major and minor illnesses and primary health issues. Once again proving to be exerting influence on reigning new labour and specifically Alan Milburn and the department of Health.

Implementation

The third and final stage after a bill has successfully passed through the cycle without too much resistance is the passing of an Act creating a statutory set of guidelines. The Labour government had prided itself a consultative system of policy making and a example is the Guillebaud committee and its role in the process.

The major ideological shift of care for those with long term needs from state maintained institutions was Thatcher rolling back the state in Health Policy. The Care in The community policy is a prime example of this shift of responsibility. The large majority in the commons and lack of constitutional restraints meant policy networks were strong and authoritarian. Little public reference or consultation took place and conditions were ideal for radical reform and the introduction of market forces into the NHS. Trade unions such as unison and the royal college of nursing were allowed to submit proposals only through the department of health, not specifically relay their objectives to a review board.

This sent a clear signal that Thatcher had and would continue an authoritarian control on policy making. This was based on a quantitative and qualitative belief that strong moral values should maintain social order and the neoclassical economics which would result in equilibrium due to market forces.

The reform of community care for mentally ill, elderly and those with long term social needs essentially stemmed from the white paper in 1981 Growing Older which laid the blueprint for movement to responsibility within the community and with informal carers. This culminated in the Community Care Act 1990 , the implementation was a lengthy process which took three main phases to ensure the policy was adhered to at grass root level and was successful;

“1st phase;(April 1991) New specific grants were to be made for services to people with mental illnesses and to drug and alcohol abusers. Local authorities should concentrate on these areas first.

2nd phase;(April 1992) Local authorities should publish their first community care plans, having discussed them with health authorities, professional workers and consumers, etc., to determine need.

3rd phase;(April 1993) Local authorities were to take on full responsibility for care in the community (Turner,1989).”

Nursing practice and health care,hinchcliff.s pg797

Evaluation

The community care policy in the NHS has been a long running and fundamental ideology, which has evolved with different governments and been adapted to their political style and the needs of society. It culminated in the implementation of the Community Care Act (1990) as discussed earlier.

The main problem with the Act was that the generic term community is given a lot of responsibility when there is no fixed definition of what a community is and how it functions. Essentially the effects of modernity have changed the fabric of communities. The break down of social ties and increased individualism means that there are no longer an abundance of close knit communities. How can a community care when it has evolved to a more fragmented neighbourhood? Another important criticism come from the feminist lobby which believes the whole act is flawed as it not only relies on a community to deliver, but for females to be informal carers. This is presumptuous as the role of women has evolved from homemakers and care providers;

“Women’s secondary status in the labour market and the social security scheme is closely related to assumptions about gender roles within families, and in particular women’s responsibility for caring work. There is significant need for care in modern British society…there is some limited public and private provision for such care…what is more, evidence suggests that this inequitable division of domestic labour is widely endorsed by public attitude.(Kiernan, 1991)”

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