Every nation dates the beginning of its welfare system from a different date. In Britain, we usually date it to 1909 and also 1942 – because that was the date that Sir William Beveridge published his famous report.
It’s the only government report in history to have reached bestseller status. British soldiers went into action against the Nazis with it in their pocket.
It provided hope, but it also set out the blueprint for the future, caring world. But there was a problem there, in retrospect, that goes to the heart of why public services remain such fraught political footballs.
Beveridge assumed that services would get cheaper over time, because need would be reduced. He assumed – as so many of the pioneers of services assumed – that they would also make people permanently healthier.
It didn’t happen. Beveridge set out to slay what he called the Five Giants – Ignorance, Want, Squalor, Disease, Idleness. The problem is not that he failed to vanquish them. He did. But something he never expected happened.
They came back to life again every generation and have to be slain all over again. And every time, it gets more expensive not less.
We now accept that so thoughtlessly that we rarely ask whether there is any way around it – but the next generation of policy-makers are going to have to tackle this question.
That means that future political debate about services is going to be dominated by the word ‘prevention’. How do we make sure our public services do more than just treat or help people when they have problems – how do they reach out upstream to prevent these problems happening in the first place?
How we afford the up-front investment we need, without scaling back the services on offer now?
How we can invest to protect society in the future against big issues like a changing climate?
And how do we turn public services also into engines of local renewal, so that they don’t just treat us – they stitch us back together again to face the future?
I have an idea that this may mean far less demarcated services, far fewer competing agencies tackling different aspects of our lives – and services set free to experiment.
They are already doing this in small ways – banning smoking in public places, insulating homes, and the Wigan fire department is now spending half its time fitting smoke alarms. But what kind of institutions will we need to do it in big ways?
And can we change the bias towards helping the needy that provides the motivation for every charity and welfare programme? How do we galvanise the system to prevent need in the first place?
That is why I’m plugging a conference organised by the New Economics Foundation on 9 May on ‘The Wisdom of Prevention’, with speakers including Jonathon Porritt and Adair Turner.
These are complicated issues, and they will make their first appearance on the political agenda at the next general election.
* David Boyle is a member of the Federal Policy Committee and a fellow of the New Economics Foundation. His new ebook is about the history of the allotments movement.
* David Boyle is a former Lib Dem parliamentary candidate and the author of Tickbox (Little, Brown). You can buy the book from Hive or Amazon.
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16 Comments
I think the problem with the welfare system is that it was designed to work in conjunction with job stability, workers rights and increased prosperity. A lot of the red tape cutting and community destroying demands of the dominant view of capitalism since the ReaganTthatcher?Blair years have been deliberately anti worker and aimed at lowering wages, removing stability. and getting sections of the community to accept poverty as natural, whilst at the same time blaming it on the poor. We need to rebuild the idea that being liberal and egalitarian are good things, rather than bending over to accept the demands of the upper strata of wealth creation. To an extent we all create wealth.
I’d like to point out that since Beveridge’s days, the population of the UK is unmistakably much less ignorant, healthier, and wealthier. Poverty has been more or less eliminated.
The extent to which people declaim the status quo as being bad at these things is unchanged. We made up a new definition of poverty so that a similar proportion of the population could be labelled ‘poor’.
I would suggest that there is a consistent level of dissatisfaction with these aspects of society regardless of how good or bad they are objectively, and the goalposts will always be moved to be a long way ahead. Nothing wrong with continuous improvement, but it’s important to do everything you can, and not waste time obsessing over the things you can’t.
We can make these things better. We can’t make people happy or satisfied.
Andrew: when thousands of children in the UK are going hungry, and 1 in 5 mothers are skipping meals to feed their children (http://www.independent.co.uk/life-style/health-and-families/health-news/look-back-in-hunger-britains-silent-scandalous-epidemic-7622363.html) I do not think we can say we have “more or less eliminated poverty”.
The original assumption was a foolish one. Everyone still dies, often in ways that are slow and require a lot of care. Was it really the case that no-one at that time realised that if you put in measures which worked to stop people dying young they would still die later? If we wished to cut care costs, one of the most effective ways we could do it would be to encourage the smoking habit, since that habit works well to kill people off at a stage in life when they have gone through their most productive period and before they require lengthy care in old age.
@ Matthew Huntbach
It’s a common misconception that the older someone is the more they cost the NHS and other services as to some people being old = being sick. Not so – it is the unhealthy and dying that cost the money, regardless of age. Most of the cost to the NHS is incurred during the last 3 months of someone’s life, regardless of age. A child dying of cancer costs roughly the same as someone in their 60s.
The real problem is the age at which people first contract conditions which limit their quality of life and gain various disabilities. They will still live for a long time through medical and social care interventions – which comes at a cost. Encouraging people to smoke will decrease that age, but not their lifespan, thus increasing costs whereas a smoker who quits in their 40s will gain 25 years of healthy life (as various toxins leave the body) thus decreasing costs.
If costs are to be minimised then the proportion of healthy life to lifespan needs to be increased through a healthy lifestyle (diet, exercise, minimising smoking + alcohol use etc.) – however there will always be a cost, which isn’t based on age, when someone dies.
p.s. Citation needed by me: Much of the above comes from a colleague at the Newcastle Institute for Ageing and Health and unfortunately I don’t have a cite-able reference to hand at this moment. Will post a followup comment later.
The state should only be expected to ensure opportunity, it cannot be its responsibility to pay for the comfort of those that do not take responsibility for themselves. Too frequently people now look at the state to offer a hand out rather than seeing what they can do to seize a hand up. Prosperity comes from education – when the state offers fourteen years of this to everyone free there are few excuses for not being autonomous and self-reliant.
Personally I note the ever increasing cost of the welfare bill with despair – an ever more burdened and all too frequently low child bearing population, being asked to pay for a more readily expanding and all too infrequently self-improving class for whom work is not aspired to – I can’t see how the social contract as it exists at present is going to continue to be sustainable.
Richard, of course I would not really want to encourage people to smoke. Neither am I saying being old is being ill. My point is really that in your second paragraph, as we get older conditions requiring medical intervention become more common, and in your first paragraph however healthy we are in general the costs of supporting us at the end of our lives remain. From the state’s point of the view the ideal person is someone like my grandfather – never had any medical treatment all his life, dropped dead from a heart attack a few weeks after retiring.
In reply to Andrew Tennant, you seem to have missed the point entirely. Health care costs are pretty random, one person may cost huge amounts over a lifetime for health care costs, another very little, and it has nothing to do with personal choice. Also I do not agree at all with the general tone of your message. I’m afraid many of the opportunities that used to exist for starting your own business have gone – look how many small businesses are clsoing down because they can’t compete with the big ones, as an example the opportunity to make a living owning a bookshop has gone now most people buy their books through Amazon. Many of the casual labouring jobs that used to exist and provide employment for those who are not that intellectually able have gone. Those that exist can easily be filled by young, fit and reasonably intelligent people from poorer countries willing to come here on a temporary basis. So why should any employer take on someone who is native to this country and in the lowest quartile of ability? People who are able, intelligent but not young also find it enormously difficult to get employment – to dismiss anyone who can’t get a job in the way you have, well, I note you’re a member of my party, and I’m ashamed of that if that’s now a typical attitude in it.
Andrew Tennent is indicative of why this party will be dead in May. Court the disenfranchised and vulnerable in election, clobber them in power.
I honestly don’t know why I’m bother with the lib Dems anymore. Andrew, if everyone was educated to the same standard who would work for minimum wages, who would stock your supermarket shelves, sweep your roads and collect your bins, The whole notion that education is the key is a deflection,. Education is a by product of of wealth,, It isn’t an equal opportunity because the starting points for it are different. And judging by this Governments dismal record on youth unemployment it isn’t even that great at getting people jobs, anyway. If you lose the drive to make society better and nicer you end up back to the good old days of slums and rickets, And all this a “class of people” nonsense needs to stop. It disenfranchise voters by labeling them as somehow irrelevant to the debate, covers up blatant racism in the employment market and sounds odious.
It’s worth remembering that the disabled, the poor and the old vote. As do public sector workers. This party has shot itself in the foot by listening to newspapers rather than it’s voters, Come the next election you will not just be facing labour and the Tories, The Greens and possibly even Respect will take seats, because guess what only a tiny minority of Lib Dem Voters ever came from a right wing economic bias.
Andrew Tennant…….. Personally I note the ever increasing cost of the welfare bill with despair – an ever more burdened and all too frequently low child bearing population, being asked to pay for a more readily expanding and all too infrequently self-improving class for whom work is not aspired to…………………
Are there no prisons? Are there no workhouses? I have read some of your other posts and, like Matthew Huntbach, I cannot reconcile your views with my definition of what being a LibDem is all about.
Andrew tennant,having read some of your posts on here and if you are an example of what the LD’s are about I can safely say you will never get my vote again,the LD’s are becoming more Tory than the Tories.
I could say a trite platitude that eternal vigilance is the price of liberty, but the idea that any of Beveridge’s five giants would or could be slain was fundamentally unrealistic in the first place.
Ignorance, Want, Squalor, Disease, Idleness: they do not go away, they are constantly there in the shadows, poisoning the atmosphere.
I do not accept that the changes in society since his day indicate a general improvement or a decline, but something a bit more complex.
The mass of access has grown and the range of options available has exploded too: the fruits of liberal democracy have proliferated. And this brings fresh challenges.
Total knowledge is much greater than before, but a by-product is trivia. The total number of goods available to a consumer increased, filling need but stimulating desire. Waste is an inevitable product of refinement. Human responses to our changed environment require new coping mechanisms. And it is all a result of becoming detatched from ourselves, alienated from neighbours and unappreciative of the philosophy of life.
The role of the state must be ever-evolving to fit the conditions of the moment better – prevention requires preparation.
Surely the whole point is that the needs of an integrated system of well-being and social cohesion?. The Beveridge report as instituted by Nye Bevan, was for those times and against a different political environment. Whatever it was and is, it was not the only iteration of possible implementations of the principles behind Beveridge. It is, as the contribution from Glenn essentially says, so much more than an acute NHS. It is the entire social environment that needs to be addressed.
To imply that Beveridge was/or is, an impossible aspiration misses the point. Much like saying the poor we always have with us and thus nothing can be done. Well something positive certainly was done for the nations’ health by the Bevan incarnation of the NHS, despite the constant subsequent counter-ideological political interference by mainly Tory and latterly, Nu-Labour administrations.
The tragedy is that we never achieved the integrated social care system that was originally envisaged. We got a National “Sickness” Service system that was/(still is for now) one of the best and cost efficient in the world at what it does. Yes, really.
It is certain that whatever the Health and Social Care Act 2012 actually is now, after all those amendments – and I’m not certain that anyone is actually sure of the devilish detail, (Certainly not Lansley). It is not nearly a solution to the problems of Health and Social Care. David Boyle is right, inasmuch that the debate on what needs to be done, is far from over. If the New Economics Foundation conference can be part of that then fine. As Liberal Democrats we should be making policy on the evidence base. Not some evidence free White Paper, that a proto-secretary of state for health walks into the DOH with under his arm two days after an election. The bill should have been dumped. It wasn’t and we are where we are but that is far from the end of the matter.
It’s difficult to campaign effectively on a platform of supporting a government which is busily trashing most of your principles. This posting is, however, the sort of thing which might just offer us a bit of hope. To concentrate on prevention, as the author does, is thinking outside the box. It can be justified as getting more for your money, so that it is still valid to explore it and advocate it despite all the cutbacks we have signed up to (to some extent necessarily, to some extent not).
This isn’t the answer to life the universe and everything, but, it’s ahead of most of the stuff we’re pushing right now.
Matthew,
Even when retired, the over 65s still make a net £40billion contribution to the economy through part-time work, savings, the industries that cater to their needs and also through them volunteering. I think the best outcome to hope for is people continuing to live as healthily as possible for as long as possible. There’s a very good report called Gold Aged Pensioners by WRVS at http://www.goldagepensioners.com.
I do recommend that everyone has a look at the Changing Age website (http://www.ncl.ac.uk/about/values/societal/changingage/) for more information about ageing and how societies attitudes (plus infrastructure and services) need to adapt – there’s going to be a lot more older people, living longer and being more healthy and economically active than previous generations of older people and society needs to make the best use of this valuable resource of expertise, labour (keeping active through even p/t work can delay degenerative illnesses) and consumers.
Glenn – while I disagree with Andrew T here quite a lot I think your citation of youth unemployment is a red herring. The current government came in when youth unemployment was near as makes no odds to 1 million; today, it is near as makes no odds to 1 million. At worst they have sat on their hands; under the previous government youth unemployment had risen fairly noticeably pretty much every year for about 7 years, so a levelling off could be argued as a step forward!
Andrew Tennant expresses an interesting position here. Apart from the fairly obvious point that many people in poor health had little opportunity to build up health insurance, is he saying that NHS hospitals should do nothing for smokers who get lung cancer or for drug addicts or for women beaten up by their violent partners after they were offered an opportunity to leave them?
Undoubtedly the welfare state and the NHS have run into problems Beveridge didn’t anticipate. The persistence of poverty alongside prosperity is one. Health problems like obesity would have surprised him: in his time, poorer people were undernourished and obesity was found mainly among richer people. While Richard Shaw is right to point out that living longer isn’t in itself a cost to the state, our ability to keep people alive after devastating damage to their bodies or the failure of vital organs is a cost. The most efficient way of funding action on these things, though, still seems to be general taxation. In the USA dependence on private health insurance led not only to gross inequalities of treatment, but to a huge deployment of resources into advertising and admin compared to the relative simplicity of the NHS .
Relating this to another post – clearly a lot of the answers lie in health problem prevention. This includes nudging and persuading people towards healthy choices, but also reducing poverty, because it is the cause of many health problems still.