The principle of public health services, well administered under the poor law, were at some point in time free of charge but the charges were made for the social services that were administered by the local authority, established back in the nineteenth century. Well before the Second World War, the only publicly funded social care for the elderly in the society was attained through the Poor Law, or better still public Assistance, in the Government act 1929. From as early as 1601, the Poor Law required each parish to pay rates to cater for the destitute people who have no family support. From 1885, the poor law health care was made available to all those who were not in a position to afford to pay for it, regardless of whether they received poor relief. The Poor Law was amended in 1834 with an aim to withdraw relief from those who are deemed capable of work (Svallfors & Gooby 1999).
The destitute, including the mentally handicapped, could be admitted to bleak workhouses. In other words, the older and the disabled were separated and accommodated in different places where they were granted sufficient amounts in terms of weekly benefits. This broad framework was carried forward into the post war times. From 1948, all of the health services were free at the point at which they were being delivered. The local authorities were bestowed with the responsibility for social care either through the independent institutions that were supervised by the local authorities or acted directly (McAdams & Aubin 1998).
From 1950s, the emphasis shifted from the institutional care to community care due to the clients’ preference, with the belief that it would certainly improve the quality of life that the elderly and the disabled people lived. It also improved the medical knowledge base and the treatments became more successful. This step was also taken to make the community care cheaper when the cost and demand for the health services were expanding. In 1948, the National Assistance Act 1946, replaced the Poor Law and this led to the establishment of the National Assistance Board. This saw all the hospitals absorbed into the National Health Service established in 1948 (Barr 1993). This, thus, led to the division of the sick, who were admitted to hospitals and those in need of medical care and attention were placed in residential houses.
This National Assistance Act required the local authorities to make available the accommodation of the elderly who had no place to stay. They were also given the power to look over and register homes run by the nonprofit and private organizations. All the National Health Services were free of charge at every point of delivery and the local authorities were in a position to levy charges for social and community services. A role for personal payments and voluntary actions were consistent with William Beveridge’s vision of the brand new “Welfare State” (Hayes 2004).
Beveridge’s work outlined the main challenges that face the social policy as the five giants, namely Ignorance, Squalor, Want, Disease and Idleness. This led to the introduction of the social insurance, as a means of addressing these challenges. Other elements of equal importance were education, employment, healthcare and housing (Community Care (Direct Payments) Act 1996). Beveridge argued that the state plays an important role in guaranteeing the basic and very necessary resources to its citizens as well as the main provider of resources. Every citizen would contribute to this system through national insurance payments, set to suit an individual according to their financial capability and they would use it to suit their individual needs (Lynes 1984).
Beveridge’s principles had many impacts on the British welfare state. The most important were the Family Allowances act of 1945, the National Insurance Act of 1946, the National Health Act of 1946 as well as the National Assistance Act of 1948 (NHS (Primary Care) Act 1997). Beveridge advocated for the family allowances that aimed to eradicate adverse child poverty. The National Insurance Act of 1946 is also another important measure in the British welfare history. It brought a unified and compulsory insurance scheme that was meant to cover the risk of sickness, unemployment and maternity as well as paying for the funeral expenses alongside providing for pensions for the elderly in the society (The NHS and Community Care Act 1990 1991). The implementation of the National Health Services in 1946 is also undoubtedly one of the greatest achievements that were broadly praised everywhere. This was the first ever general National Health Service in the history of Britain (Atkinson 1999). The new changes that it brought about were the financing through the general taxation and a central national administration. There was also free admittance as well as treatment in most, if not all of the state ran hospitals where the medicine was given free of any hidden charges (Reforming the law for adult care and support 2012).
There have been many challenges to dominant constructions of care and dependency emerging from the year 1970s onwards as the succession of measures in 1970s was designed in such a way as to assist the disabled and able people in the community. The sick were told to register, but did not have adequate funds to expand the community based services as day care centres and homes helped. In 1976, there was a financial arrangement made, which was intended to aid cooperation, thus enabling the National Housing Services funds to be used on constructive projects with the local authorities.
The collaboration never attained its full effectiveness since the new authorities were not very successful and their re-organization was done again in the 1980s (Berkowitz 1991). There was also the problem of financial bottlenecks. There was an economic crisis in the years preceding 1970 and it affected the dominant construction of care and dependency. Between the years 1970 and 1975, there was a drastic fall in the number of the mental hospitals due to an inadequacy of the community support services. This was another challenge that was hard not to notice. There were also the key landmarks in the policy development. Such is the Community Care (Direct Payments) Act, 1995, which made a provision for the local authorities to make payments to the disabled people in order to assist them, however, the more precious community services were based on meeting their individual needs (Timmins 1996).
The National Housing Service, NHS and the Community Care Act 1990 made attempts to implement a way that the users of all types of services paid a reasonable amount that they could afford. This implementation was made without increasing the funding and encouraged the local authorities to become independent agencies (Clark 2001). It, thus, made it a requirement for the social services departments to inspect the services provided, create a procedure for launching complaints and prepare clearly outlined Community Care Plans (Adult social care 2011).
In conclusion, the current system of social healthcare has its roots in the pre-war system. Over these periods, more so in the 1980s and 1990s, the responsibility and the care of the elderly and the disabled has shifted from the institutions to the community, and then from the public to the independent sector. Through all this time, the charges rose. It is true to say that the history casts a long shadow when it comes to matters pertaining to the care of the elderly and the disabled, because it started way long before the pre-war eras and is still affecting the way the current healthcare system operates in Britain. It encouraged the idea of the people in need of care and control being segregated and it affects greatly the modern way of care for the elderly and disabled in the society (Pierson & Castles 2000).
