MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

Introduction
Many Britons take State provision for social security, health care, personal social services and social housing for
granted. These are commonly included in people's lists of concerns. Before the 1940s there were very few facilities
and it was felt that the state was not obliged to supply them. There is state (public) and private provision which reflects
the historical changes.
The state provides for the sick, retired, disabled, elderly, needy and unemployed. Some services are reserved
by the UK government (social security and most health care, except for Scotland). Other provisions are organised by
devolved authorities, for example, housing, child care and social care.)
Costs are funded mainly by general taxation and partly by the National Insurance (NI) Fund, to which
employers and employees contribute.
Many social services are free at the point of need, but most people will have contributed to them whilst working via
income tax and NI contributions.
Private sector provisions tend to be financed by personal insurance schemes, company occupational plans
and by those who choose to pay out of their own income or capital. However, most of these people are entitled to
public sector care if they wish.
There are many voluntary organisations that provide charitable help for the needy, which are generally funded
by public donations.
Reforms to the state sector were made during Conservative governments (1979-97) in order to:

reduce expenditure
eradicate fraud
improve efficiency
encourage more self-provision
target benefits for those really in need

These were attacked as being based on market orientation and a return to the old mentality of personal responsibility
for social needs.
Labour governments since 1997 also made reforms:

encouraging private insurance against unemployment and sickness

private provision for pensions and old age care
help for families
reduce poverty and exclusion
efforts to return the unemployed to work

Critics do not consider the reforms to have been wholly successful and extra public spending was required (i.e., in the
NHS) to prevent decay and possible collapse.
In the future the state may not be able to financially maintain public social services without increasing taxation.
Public-private partnerships were introduced by the Labour government for the provision and management of ublic
services, but these were seen as privatizing free social services.
History

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

Historically, there were no state social services for the majority of Britons. Some protection against poverty, illness and
unemployment was provided by the church, charities, the rural feudal system and town guilds (organisations of skilled
craftsmen).
In the 16th century, the state was not expected to be responsible for social services. This continued throughout 18th
and 19th centuries, although conditions worsened with industrial revolutions and a rapidly increasing population.
Public health became a problem due to living conditions (diphtheria, typhoid, tuberculosis, smallpox and measles were
endemic).
As 19th century governments refused to allow trade unions to prevent an uprising amongst workers, self-help clubs
were created to provide basic protection. Benevolent employers providing decent housing and health facilities existed
but were few and far between.
Limited reforms in housing, health, factory and mine conditions, sanitation and sewerage, town planning and trade
unionism were implemented in the 19th century. The problems were considerable and the states failure to provide
major help made the situation worse. There was apathy and vested interests in Parliament and the country.
DATE
1558-

CHANGE
Poor Law (England)

1603

OBSERVATIONS
The state took over the organization of charity provisions from the
church. Through taxation parishes were responsible for their poor, sick
and unemployed. Housing, help and work relief were provided. But

1834

Poor Law Amendment Act

provision was grudging, limited and discouraged reliance on it.

Designed to prevent abuse of the parish social relief and reduce taxes

(E. & W, later Sc).

needed to fund it.

Workhouses were created for destitute and needy, but were dreaded

Public health apparatus was

by the poor and were a last resort.

Some towns created local boards to initiate health schemes in 19th

1848

created
An effective national system was

1875

put in place
Progressive Liberal governments

Early 20th century state admitted it had social responsibility for all

introduced reform programmes

society. Reformed old age pensions, NI, health, employment and trade

1905-

century.

1922
unionism. Basis of the future welfare state, but limited to a minority.
Expansion of social services was halted due to the financial problems caused by the 1914-18 war and the economic
crises of the 1920s and 30s.
1942
Beveridge Report

Model for a welfare state. Recommended a comprehensive social

security system and free health care for all. Intended financing through

Labour government radically

NI scheme. Some legislation passed by Conservatives.

Creation of the present welfare state. Gradual realisation that most of

1945-

altered the social and health

the cost would have to be provided via general taxation.

1951

systems

Household and demographic structures

The provision of contemporary social services (both public and private) is conditioned by:

changes in household structures

demographic factors (birth rates, increases in life expectancy, etc)

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

governmental responses to social needs

availability and cost of services
individuals personal financial resources

It is said that the typical British family (2 parents and 2 children living together) is falling apart: failing to provide for its
elderly and disabled; suffering from social and moral problems; lacking parenting skills and looking automatically to
the state for support.
Marriage:
Statisticians predict married couples will be outnumbered by those who never marry, with a greater increase in
unmarried men than women. The increasing in cohabiting couples (couples living together outside marriage) will not
compensate for the decrease in marriages. Divorce rates are already declining.
More adults will be living alone in the future. People of all ages who may be single by choice, divorced, separated,
widows or widowers.
Marriage is still the most common form of partnership for men and women with more people delaying it for career and
other reasons (average is 28y for men and 26y for women).
In 2006, the divorce rate was 12.2 divorces per 1,000 married men/women, the lowest since 1977. Remarriages and
people marrying under 21 y are most susceptible to divorce. Remarriage rates are double for men than women (28.4
compared with 13.8) and the most common divorce ages for both women and men were between 25 and 29y. Divorce
affects a significant number of children under 16y, and the trauma is increased by the system, with conflicts arising
over property, financial support and custody.
Associated with the drop in the rate of divorce is the large increase in cohabitation (couples living together outside
marriage).In 2006 there were 1.8 million cohabiting couples in England & Wales, expected to rise to 3 million over the
next 25 years. Eight out of 10 resulting births to couples are registered by both parents, unlike before. Adoption by
some registered civil partners and same-sex couples is also on the increase.
Births:
Non-marital births (cohabitation and single mothers, including under 18s) accounted for 46% of live births in 2009.
Although there has been a reduction, figures in 2010 showed that Britain still had the highest unmarried teenage
pregnancy rate in Western Europe. Legal standing of such children has been improved by removing inheritance
restrictions (for example), but there is still controversy on moral and cost grounds and some of the old stigma.
The average UK-born woman has 1.84 children; those from abroad have 2.5 children; a quarter of babies in 2008
were born to women who came from outside the UK.
Childbearing has been delayed with women in Britain having their first child on average at 28y (compared with 21y in
1971).
Population:
In 2003 the British population was 59.6 million and 61.4 m in 2009, the greatest population increase in 50 years.
Projections suggest it will reach 65m by 2050.

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

Between 1971 and 2003 there was an 18% drop in the number of children under 16, and a 28% increase in people
aged 65y and over.
The over 65s will exceed the under 16s by 2013. Life expectancy of men is 75.7 years and women 80.4 years.
The population is growing at a rate of 0.7% every year, double the figure for the 1990s.
6% of over-65s and 7% of disabled adults live in state or private institutions. Most disabled people are cared for by
their family, and most of the elderly by their families of they live alone supported by social services. The burden upon
families will grow as the population becomes more elderly, state provision is reduced and the numbers of disabled and
disadvantaged increase.

Social Services (Pensions and Welfare)

Operated by local government and the Department of Work and Pensions in most parts of the UK, the system is
complicated. British people may receive payments from:

contributory National Insurance

means-tested benefits
non-contributory benefits
universal benefits
discretionary benefits

Contributor system provides:

relatively low state retirement pensions (to working women 60y, men 65y, all at 65y from 2010, rising to 68y by

2050)
maternity pay for pregnant working women
statutory sick pay (workers absent due to illness of who become incapable of work)
Jobseekers Allowance (those who become unemployed and actively seek work)

Income-related benefits, usually after means-testing include:

1. Income Support
1.1. Received by 5.6 million people; 1-parent families, the elderly, long-term sick and unemployed
1.2. Covers basic living requirements (although relatively low sums)
1.3. Includes free prescription medicine, dental treatment, opticians services and childrens school meals
2. Working Families Tax Credit
2.1. Families with children and at least 1 parent in low-paid work receive a tax credit to increase earnings
3. Child Tax Credit
3.1. Supports families with children, dependent upon income and number of children in family
4. Housing Benefit
4.1. Paid to those on Income Support and covers the cost of rented accommodation
5. Child Benefit
5.1. Tax free, paid to ALL mothers for each child up to 18y, not means-tested (15/week eldest child, 10/week for
other children)
The benefits system is not perfect; 27% of British people are on different types of income-related benefits, and it is
said that a quarter of the population exist on the poverty line (60% of the average national income = 11,500 approx).
But accurate figures are difficult to receive as official statistics vary depending on definitions used.
Welfare benefits are very expensive and the aging population will only make it more so. They are also subject to fraud.
From 1997 the Labour govt tried to reform the system to attack fraud, cut expense and reduce benefits while still

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

targeting those with greatest need. Govts argue the cost of social security is unsustainable and encourage greater
self-provision but it is difficult to protect the genuinely needy and make people more self-reliant and independent.
All political parties campaigned at the 2010 general election that it was unacceptable for people who can work to reject
it and live off benefits.
Future pension problems can only be solved by increased taxation, workers working longer and saving more for
retirement, or a combination of the two.

The National Health Service (NHS)

Created by a Labour Government in 1947, based on the Beveridge Report recommendations, it replaced a private
system of payment for health care with one of free treatment for all at the point of need. Hospital and most medical
treatment under the NHS is free for British and EU citizens. The NHS provides medical and dental services for the
whole country.
However, some charges are now made:

prescriptions (free for under-16s, people on social security benefits, and old age pensioners)
some dental work
some dental checks
some eye tests

Payment depends on employment status, age and income. NHS dental treatment is in serious trouble and many
dentists have left the NHS for private practice.
In the 2010 budget, the NHS and health care was estimated to cost 122 billion pounds of total govt spending; it is the
biggest single employer of labour in Western Europe. State health expenditure in Britain is only 8.8% of the GDP and
lower than in other major Western countries.
The term NHS usually refers to the UK as a whole, however, the UK govt funds the NHS for the whole country and is
responsible for the NHS in England (via the Dept of Health), while devolved authorities in Scotland, Wales and
Northern Ireland handle their own health matters.
The Labour govt created 2 health care levels: primary and secondary.
Primary Care Trusts (PCTs):

control 2/3 of NHS budgets at local level

first contact for patients
assess local needs
commission care
include health professionals (doctors, etc) and hospitals.

Secondary care:

acute emergency and specialist care (following a referral from a doctor or primary care)

Both levels work with Strategic Health Authorities (SHSs) to manage and improve local services.

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

The current coalition govt intends to abolish PCTs and SHSs, cut bureaucratic costs, give finance and health
commission duties to GPs and make all hospitals independent of Whitehall control.

Doctors
Most people in Britain will go to their NHS-funded GP first (there are about 35,000). Doctors have an average of 2,000
patients on their panel (list of names), although they only see a small percentage regularly. Most doctors are members
of group practices, sharing larger premises, services and equipment. This also allows for minor surgery. However,
patients are usually on the panel of one specific doctor (personal choice).
Another option is to use the NHS Direct Service, a telephone helpline manned by nurses. Its effectiveness is
debatable.

Hospitals
If further treatment or examination is needed, GPs refer patients to specialists or consultants normally based at local
NHS hospitals or Trusts. NHS Trust hospitals are self-governing to a large extent, funded by contracts with Primary
Care Groups. They can apply to be foundation hospitals which run independent budgets and services.
Britain has very modern hospitals are more are being built, but it also has many 19 th century buildings urgently
needing modernisation and repair. There is a shortage of beds with ward and hospital closures. Waiting times for
consultancy visits and operations, and treatment in A&E departments are still a major concern.

The State of the NHS

The NHS is praised by the public for:

its work as a free service

its achievements
people generally receive help when needed
many who would have died or suffered are surviving and being cared for
being a success in terms of consumer demand
standards of living and medicine have risen
better diets devised
greater health awareness in the population at large

The NHS is criticised for:

alleged inefficiency
inadequate standards
treatment discrepancies throughout the country
scandals
bureaucracy
objectives are deemed too ambitious for the amount spent on it
the media draw attention to shortcomings
NHS workers complain about low pay, long hours, management weaknesses, levels of staffing and cuts in
services

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

Increased spending by the Labour govt has not eradicated problems which many believe are caused by managerial
inability to organise funds competently where needed.
NHS can be thought as a victim of its own success, and despite problems much of it works well and is good value for
money.
Improvement suggestions each have their own problems:
Increased govt spending

increase in taxation

Charges for some services

against principle of free health care (population agrees if service is better)

Efficient management of existing funds

Private sector involvement

possible not enough savings

poorer people not included; regarded as a form of NHS privatisation

The previous Labour Government was committed to increasing NHS spending to European levels, reducing
management costs, transferring money to medical care and staff and reorganising the NHS administration. But the
public saw little improvement and was disillusioned and concerned.
In 2001, the WHO ranked Britain as 24 th out of 191 countries in terms of efficiency of its health system. But a 2007
Brussels survey said Britain was 17 out of 29 European countries for healthcare benchmarks including quality of
service, length of waiting times and patient information.

The private medical sector

To help with public sector problems the private sector has become involved in providing health care.
Private Finance Initiative (previous Conservative govt) allowed new health facilities to be built, maintained and owned
by he private sector, but leased to the NHS to provide clinical services and control planning and clinical decisions.
Seen as complementary to the NHS. The idea was to:

Release pressure on state funds

Give choice to patients
Allow sharing of medical resources
Provide flexible services
Result in cost-effective cooperation with the NHS
Allow treatment of NHS patients at public expense in the private sector

The Labour govt (unusually) continued the initiative. However, the scale of private practice in relation to the NHS is
small and is often confined to minor medical cases while expensive, long-term care is still carried out by the NHS.
25% of operations and healthcare in Britain is paid for privately by patients. Private medical insurance covers some
6.9 million individuals and 4.8 million people in company plans; reason for doing so include concerns over waiting lists
and standards of health care.
Insurance policies pays for private care in private hospitals and clinics or in NHS hospitals which provide pay beds
(beds for the use of paying patients, a concession to doctors in 1946 who agreed to join NHS but wanted to keep a
number of private patients. These still exist.)

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

THE PERSONAL SOCIAL SERVICES

The state (public) sector

State social services provide facilities in the local community to assist the elderly, the disabled, the mentally ill,
families, children and young people.
There is increasing pressure on social services, families and carers as the elderly population grows and the number of
disadvantaged rises. Elderly people may have to sell their homes to cover some or all of their expenses. However, in
Scotland residential and medical care is free under devolved legislation. There is severe staff shortage in both public
and private sector.
The previous Conservative govt introduced a Care in the Community programme, continued by Labour. Financial
and material support to families an carers looking after elderly or disabled relatives, or disabled children and adults in
the family home. Psychiatric patients who do not need constant care, elderly and disabled people can be cared for in
their own homes by the social services. The aim is to prevent people becoming institutionalised and to give them
independence.
Difficulties have been: mentally ill and disabled people becoming homeless, or receiving inadequate accommodation
or neglecting their medication. Some elderly have received poor attention and help.
Personal social services help people with learning disabilities. Children in need after family breakdown or
dysfunctional parents are supposed to be protected in residential care accommodation or fostering and adoption
services. There have been several serious physical and sexual abuse cases in care homes and deaths in family
homes from neglect or abuse recently, social services have been heavily criticised as a result.

The private social services (voluntary) sector

The private sector supplies various care facilities, but these are declining due to costs. Luckily voluntary charities and
agencies have remained. The state system cannot cover all needs without them.
Most voluntary agencies have charitable status, meaning they receive tax breaks on their income but receive no (or
little) financial support from the state. Some are small and collect limited public donations, others are very large with
professional staff and receive millions from many different sources. For example, Oxfam is now an international
organisation.
Examples of voluntary agencies:
Barnardos

help needy children

Church of England Childrens Society

Cancer Research Fund

cares for neglected children (Britains largest adoption agency)

gathers finance and research cancer cures

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

Peoples Dispensary for Sick Animals

SOCIAL SERVICES

free veterinary aid for peoples pets

Samaritans

telephone helpline for suicidal

Age UK

campaigns for the concerns of the elderly

Housing
Of the 25 million domestic dwellings, 69.8% in 2007 were owner-occupied and 12% were rented out by private
landlords. 18% is social housing, rented by low-income tenants from local govt authorities or housing associations
(non-profit-making bodies that manage and build homes for rent and sale with the aid of govt grants).
In both public and private sectors 81% of the British population live in houses or bungalows, and 19% in flats and
maisonettes. Traditionally, houses are divided into detached (22%), semi-detached (32%) and terraced (27%),
detached properties being more expensive and having greater prestige.
In England social housing is controlled by the Dept of the Environment, and by devolved bodies in Wals, Scotland and
N. Ireland.
The Conservative govt (1979-1997) encouraged home ownership as part of its programme to create a property- and
share-owning democracy. It was critical of public sector policies. In 1980 it introduced a right-to-buy policy by which
local govt could sell off council housing to sitting tenants at below-market prices. This increased home owners by
1million and relieved local authorities of decoration and maintenance costs.
The Labour Party accepted this policy, after initial opposition, as it was attractive to tenants. It returned the revenue
from such sales into local govt (previously not allowed) so it could provide more low-cost social housing. Thus some
control of housing policies was returned to local govt.
In real terms publicly funded new-build social housing has declined and the private sector is not building enough lowcost or affordable housing. The Conservative govt policies are thought to have contributed to a serious shortage of
cheap rented accommodation for low-income groups, single people and the unemployed, at a time when demand was
(and is) growing. Demand by one-person households is projected to reach 8.5 million by 2021.
Private sector home ownership has increased by 10% since 1979. Normal procedure is to take out a mortgage from a
financial institution. The amount depends on the borrowers salary with 3 times the gross annual salary being normal.
Repayment tends to be 25 years with interest.
House prices vary: London and SE England are the highest, northern England, Wales and Scotland are the lowest.
House prices rose dramatically in the 70s, stabilised and then rose again in 1986-88. This was followed by high
interest rate, and an increase in mortgage foreclosures (repayments cannot be made, the financial institution
repossesses the property and the occupier becomes homeless). The market recovered slowly from 1994 and prices
increased spectacularly again critics saying that properties were overvalued. The 2007 credit crunch made the
housing market collapse, factors included reckless mortgage lending, huge personal debt and chronic oversupply of
new properties (especially buy-to-let flats at high rents). Foreclosures increased.
The standard of construction of houses in Britain is variable. Older houses are old, damp and cold, frequently badly
built and lack central heating and adequate insulation. Govt grants mean greater attention is paid to insulation and

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

energy saving than before. But with higher building costs and less available land, the trend in new-builds is flats and
much smaller rooms in houses.
Some areas have dreadful living conditions, almost slum-like. Recently completed tower blocks have had to be
demolished due to defective and dangerous structures. According to the National Housing Forum, 1.8 million British
homes are unfit for human habitation.
Town renovation and slum clearance policies from 1930s mainly removed the population of large city centres to new
towns or estates. Some new towns, e.g. Crawly and Stevenage, have been successes despite initial social and
planning problems. Council estates not so much, they have tended to degenerate very quickly. Bad design, social
deprivation and lack of upkeep are blamed for the crime and vandalism that affect many. Some local councils now
spend on modernising old areas to preserve communities, although the previous Labour govt preferred the demolition
of old properties, especially in northern England.
The provision of housing for young and single people has been a problem for many years. Those on low or even
medium wages often cannot afford to get on to the property ladder. Many end up living with their parents. Factors
include: high property prices, the desire of affluent people to have homes (or second homes) in the country, and long
waiting lists for council housing (including people who have priority over them). Alternatives include board with
parents, house-share or rent privately.
In a limited housing market, it is thought the obsession for house ownership should be given up, and new ways to
meet housing demands should be investigated. Rent legislation and new lease structures were introduced by the
Conservative govt but have led to accusations of exploitation of tenants by landlords. Labour wanted a healthy private
rented sector, improving the rights of leaseholders.
To cope with housing demand, Labour began large-scale building plans in the south Midlands, south-east and along
the south coast. This was criticised as some building would occur on flood plains while others were likely to cause
environmental damage and increased traffic congestion. It also allowed high-density housing in urban areas and within
Green Belts.
Officially there are 105,000 homeless people, but the charity Crisis says the real figure is 380,000 (130,000 being
children). Some are visible, living on the streets of large cities, others live in squats, shelters and temporary
accommodation.
Causes of homelessness are complex, but it is thought that better handling would improve the situation. Some
700,000 houses throughout England are unoccupied for various reasons, and some say their refurbishment and use
would eradicate the problem of homeless people.
Despite help and campaigning by charities and religious organisations, housing continues to be a big problem in
Britain.

Attitudes to the social services

In a poll taken in April 2010 before the General Election the majority of the British people said they were most
concerned about: Pensions, social security, welfare benefits, housing and the NHS, among other matters. In the poll,
39% said the govt should increases taxes and spend more on health, education and social services, while 50%
thought taxes and spending should be at 2008 levels.

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

Polls suggest the NHS is not considered as well run as other institutions, but such negative views may not always
accurately portray reality as personal experiences of dealings with the system are often very positive.
The huge budget deficit in 2010 of 163 billion placed social services in sharp perspective.
A 2009 Ipsos MORI poll reported:
Agreed

Disagreed

43%

44%

62%

26%

75%

14%

90%

7%

80%

14%

Spending on public services needed

to be cut
Making public services more efficient
could save enough money to pay off
the budget deficit without damaging
the services
Reducing the

number

of

NHS

managers by 1/3 would save most

costs in the NHS budget
More control over health services
should be given to doctors and
nurses rather than managers and
politicians
There should be fewer national
targets for health services and more
devolved local control

It is debatable whether the implementation of these proposals would be enough to solve the budget deficit problem.
The private financing initiatives favoured by Conservative and Labour govts are not supported by the majority of the
public as they are seen as gradual privatisation. Other criticism involved foundation hospitals and reorganisation
plans, all of which according to critics establish a market for health care.
When asked on how public services could be improved, a MORI poll from September 2001 found respondents
thought:

Better pay and conditions for public sector workers would aid recruitment (64%)
More public sector workers (43%)
More investment in new buildings and equipment for public services (42%)

In the 2010 general election campaign, all political parties committed themselves to support the NHS and frontline
services. But local councils have still approved the selling of state care home for the elderly to the private sector.
Current situation
theguardian .com
On Monday 24 November, some 400,000 NHS workers will strike, including midwives, nurses, radiographers, cleaners
and psychiatric staff. This is the second industrial action in a month. The action comes after the coalition UK
government decided not to accept the recommended 1% pay rise for all NHS employees, and will be followed by
work-to-rule action for the rest of the week.
By the end of the next financial year NHS workers will have had their pay capped for 6 years.

MUNDOS ANGLFONOS: BRITISH CIVILIZATION

SOCIAL SERVICES

Despite strike action taking place recently, public support for a 1% reward for NHS staff has remained high. A Dept of
Health spokesman said NHS staff are our greatest asset... but we cant afford a consolidated pay rise... without
risking 10,000 frontline jobs.
bbc.com
Christina McAnea, chair of the NHS trade unions, warned Health Secretary Jeremy Hunt that he needed "to realise
that this dispute is not going away". "All we are asking for is fair pay," she said.
The announcement follows a four-hour strike on 13 October, the first in the NHS over pay for 30 years. The impact on
patients was limited as unions had agreed to cover urgent and emergency care. A similar arrangement is likely this
time.
Ministers in England have awarded NHS staff a 1% increase, but only for those without automatic progression-in-thejob rises. These, designed to reward professional development, are given to about half of staff, and are worth 3% a
year on average. An independent pay review board had said the 1% increase should be across the board.
It was implemented in full in Scotland. Northern Ireland has yet to make a decision on pay, while Wales did the same
as England but did give extra to the lowest paid staff. Some unions are balloting their Welsh members about action
there.