Introduction
The health and social welfare aspect of any given society determines its prosperity. According to Castles (2002), some commentators argue that the burden of an ageing population may strain government spending, thus, causing a crisis. In this light, governments need to formulate and execute health care policies that pursue the improvement of the general population’s health status in the wake of an increase in chronic illnesses including cancer, arthritis, and diabetes among other disorders.
The United Kingdom (UK) has shown interest in developing social policies that seek to improve the people’s welfare especially the health element. Through the efforts of the National Health Service (NHS), the UK has implemented several policies that depict the government’s intention of providing an effective health and social welfare system. The NHS is responsible for the community’s health in the UK through the provision of broad services ranging from children check-ups to cash benefits for the elderly and the disabled.
Recently, the UK has experienced considerable cases of coronary heart diseases, cancer, stroke, and liver diseases that prompt the intervention of the NHS. Coronary diseases in the UK account for the leading cause of death in the society, thus, affecting the welfare of the people negatively. Therefore, for the sake of reducing the prevalence of such conditions in the UK and especially Scotland, the introduction of a free NHS welfare program is a brilliant idea that if implemented would improve the society’s health position significantly.
However, the NHS faces challenges including high government spending, access controls inefficiency, and substandard health care services that could undermine the successful implementation of the free NHS welfare policy. In this light, this paper will conduct a policy memorandum that focuses on the access control issue that has the potential of undermining the implementation of the free NHS policy by incorporating theories such as neo-liberalism, feminism, and communitarianism.
The Problem Affecting the NHS in the UK
Several challenges undermine the effective functionality of the NHS amid its remarkable achievements in bolstering the health and social welfare of the British people and foreigners. Notably, the NHS offers a range of free medical services applicable at the point of use including emergency treatment and doctor visits among other areas. However, accessing the free services has proved to be a challenge for some groups in the society particularly the disadvantaged ones. Mainly, the access controls issue hinders the equitable provision of free services to the deserving patients significantly, which renders the free NHS policy ineffectively.
The access controls problem implies that the delivery of services required to fulfil the diverse needs of patients in the UK fails to realise the objective of “invisible costs”. In this light, the NHS fails to raise the health status of the UK people as price mechanisms determine the delivery of health care services. For example, “health tourists” benefit from services that should be offered to the natives. As a result, this trend has put a strain on the financial resources allocated to the NHS. Therefore, the price mechanism that governs the operations of the NHS jeopardises the priority aspect, which is required to dispense services equally amongst the UK residents.
Consequently, the access controls issue has created a UK health care system characterised by long waiting lists that are cost ineffective. For this reason, the British government is required to inject an additional £8 billion annually to cater for NHS programs by 2020 (NHS: Five-year forward review 2014). Furthermore, the access control challenge has a negative impact on the financially unstable individuals in the UK since they cannot access certain health services that require payment. Moreover, the NHS’ access control inefficiency has barred the underprivileged including the elderly from accessing social health insurance plans (NHS: Five-year forward review 2014). Therefore, the implementation of the free NHS policy would alleviate the identified problem significantly.
The Application of Normative Theories of Welfare
The realisation of a society characterised by equality, justice, and morality is important in any setup that seeks to promote social welfare. Coz (2001, p. 465) posits, ‘the post-war period social rights provided the normative justification for building generous social programs’. Based on the same reasoning, the UK should improve its social programs as a way of attaining welfare states. As such, the implementation of the free NHS policy would go a long way in fostering the attainment of a prosperous society that enjoys unlimited access to health services.
In this regard, the incorporation of normative theories would foster an in-depth understanding of the structures that facilitate the realisation of a welfare state since such theories reveal the fundamental concepts necessary for a successful society (Lister 2010). In this respect, focusing on three normative welfare theories that include neo-liberalism, feminism, and communitarianism is essential for the NHS context.
The Neo-Liberalism Theory
The neo-liberalism theory of welfare emerged during the second half of the 20th century as scholars pressured governments to adopt frameworks that allow the existence of a free political economy (Lister 2010). Essentially, the neo-liberalism theory of welfare holds that government institution should not interfere with the economic activities negative but instead would create environments that allow free and fair competition in the diverse markets. Therefore, through competitiveness and efficiency, the society would achieve prosperity, thus, depicting the realisation of a welfare state.
However, political influence and the commercialisation of health services in various societies including the UK have undermined the efficiency of the health sector (Taylor 2007). Historically, the UK has experienced a series of policy influence from the private sector resulting in the benefit of a minority at the expense of the greater majority in the society. For instance, Margaret Thatcher’s authority saw the collaboration of senior politicians and business moguls who sought to devise economic policies that favoured the attainment of a free market.
However, despite the developing evidence that revealed the grave dangers of tobacco smoking, the government allowed tobacco adverts to create a competitive market. Thatcher allowed the thriving of the tobacco industry to achieve a “strong state” denoted by a free market system. Thus, the embracement of neo-liberalism prompts the acceptance of social conservatism amid the moral controversies that could arise after the development of a particular policy.
Notably, the access controls problem in the NHS system creates social health inequalities that exhibit the prevailing injustices and unfairness in the society. Mainly, the long waiting lists arising from poor medical service access systems affect the marginalised, socially excluded, and suppressed communities in Scotland among other states in the UK. Therefore, offering free NHS programs would imply that the disadvantaged would also gain equal opportunities to access the wide range of medical services offered. Furthermore, the strategy would pressure the private healthcare institutions to improve their services as a way of bolstering their competitiveness in the free market. Consequently, the greatest majority in the UK would benefit considerably from the free and affordable services offered by the NHS and private agencies correspondingly.
The neo-liberalism theoretical framework also allows the establishment of public-private partnerships that foster the development of an economy dominated by free markets (O’Brien & Penna 1998). Notably, the UK boasts as the pioneer of public-private partnerships in the health care sector. In this respect, the incorporation of private players in the proposed NHS policy means that the policy does not intend to create unfair competition but steer the social and economic health of the UK towards excellence.
Additionally, the incorporation of the neo-liberalism ideas would combat the access controls issue by ensuring the distribution of measurable, cost-effective, and effective public services (O’Brien & Penna 1998). Therefore, the public-private partnerships would allow the NHS to relieve itself from the pressure that emanates from the up-surging healthcare demands that have significantly elicited the access controls problem. Moreover, the adoption of the NHS system that embraces partnerships would provide an alternative source of funding, reinforce its technology and innovation, and increased transparency in the health sector.
Currently, the bureaucratic health care system in the UK also contributes to the access controls challenge that undermines the competence of the NHS in countries like Scotland. Through neo-liberalism, a particular system adopts entrepreneurial and hands-on management approaches that foster flexibility owing to the created competitiveness. As such, the implementation of the free healthcare services policy in the UK through the NHS would influence a shift from the traditional tyranny of bureaucratic structures to a more flexible management system motivated by competition. Furthermore, the neo-liberal approach would underline the relevance of decentralisation and disaggregation of the public health service, thus, enhancing accessibility besides promoting efficiency on different levels.
Therefore, the neo-liberalism theory provides a framework that underscores the relevance of a free market economy with minimum government interference. Axiomatically, the free NHS facilities policy would bolster the welfare of the UK citizens and foreigners by competitiveness in the sector, thus, eliminating the accessibility problem. Hence, the creation of public-private partnerships and embracing the entrepreneurial management strategies would considerably alleviate the problems that create inequalities in health care provision leading to the development of a welfare state. Moreover, the NHS would bar itself from political influence by promoting economy and discipline in resource allocation, thus, fostering equitable accessibility to the wide range of proposed free healthcare services.
The Feminism Theory
Feminist theorists started agitating for equal rights for women around 24 decades ago, and the outcomes are felt up to date. Previous generations witnessed significant cases of gender inequality spearheaded by patriarchy as opposed to the contemporary society’s approach towards women. However, the cases of gender inequality have not disappeared today as some societies still discriminate individuals based on the aspects of their gender.
Notably, the prevalence of gender inequalities in any particular society weakens its progress, thus, necessitating intervention. Gender inequalities in the health care system pose a significant threat to the enhancement of the people’s health and social welfare in the current society. Therefore, the integration of the feminist approach in the healthcare provision programs facilitate an examination of the nexus that exists between gender, disadvantage, and health.
Markedly, research depicts that women attain higher life expectancy rates compared to men. However, countries including Scotland reveal that women are prone to have bad health compared to men, thereby hinting the existence of inequalities in the accessibility and provision of healthcare services. Undoubtedly, the common causes of mortality among adult males involve diseases like lung cancer and hypertension.
On the other hand, the diseases that account for the leading triggers of women mortality includes semantic issues mainly comprising of pains, muscular aches, headaches, and tiredness. Additionally, in the UK, elderly women record high cases of mortality due to disability and mental illnesses mainly associated with depressive and anxiety disorders. The disparities reveal that men have better accessibility to medical services or they receive services of higher quality as compared to women. Therefore, implementing the free NHS policy would influence clinicians to uphold the essence of offering their services equally to the patients regardless of their gender.
In the UK, poverty is a chief factor that contributes to gender inequality greatly, and it gets worser when its results determine the delivery of public services. Poor women are more likely to experience discrimination when accessing health care services in the UK, and, thus, they experience greater health risks that further worsen their well-being. As noted earlier, the UK has a considerable number of disabled elderly women that have limited accessibility to health care premiums owing to their financial status.
As such, poverty emerges as a factor that prompts the ineffectiveness of the access controls mechanism adopted by the NHS. Hence, besides offering the free medical services to the poor women, there is a need to empower them to achieve greater gender equality. Women empowerment is a key strategy of promoting the society’s welfare especially the economic aspect. Women, irrespective of their social class, would gain equitable access to different services like health care.
Furthermore, the integration of the proposed policy would promote the inclusiveness of delivering public services (Spicker 2014). Notably, feminist theorists underscore that women ought to participate in decision-making processes exclusively on issues that affect them. The policy has the prospects of realising greater achievement through the incorporation of women’s opinions before making decisions regarding their health. As such, the cooperation of the clinician and the patient in the course of medical services delivery would foster the quality of healthcare provision, and, thus, enhance the social inclusion of vulnerable groups like in the case of poor and disabled women.
Remarkably, 83% of women in the UK reported that they accessed health care services satisfactorily after the clinician engaged them in making decisions pertinent to their health. Therefore, the proposed NHS policy would combat the social exclusion of women in a society that is still dominated by men by encouraging their participation in making decisions aimed at improving the free medical services.
The Communitarianism Theory
The communitarianism theory of welfare underlines the need for a connection sandwiched between the individual and the community. As a philosophical theory, communitarianism emerged in the 1980s to address the social and political aspects of a given community. Mainly, the theory focused on the functionality of the political structures besides comprehending the well-being of human beings in the society.
In the wake of unceasing health care reforms like in the case of the proposed NHS policy that pursues the provision of free medical services to every individual in need of such services, the incorporation of the communitarianism theory is crucial. Notably, the dominance of individualism in the health care system is a major hindrance to the provision of quality services at the expense of the entire community. Therefore, if the policy focuses on yielding benefits to the entire community instead of a few individuals, it would promote equality in the delivery of public services in the UK.
Axiomatically, communitarianism embraces the essence of reinforcing the bonds that harmonise the identity of communities (Fitzpatrick 2005). Therefore, the provision of free medical services in the UK under the watch of the NHS requires the consideration of the importance of recognising and harnessing the bonds that form the diverse communities for the attainment of equitable access to the services instead of ignoring them.
However, the NHS needs also to assess the aspect of individual autonomy to curtail the development of conflicts that would jeopardise the effectiveness of the policy. Notably, the elements of community autonomy appeal to both the individual and the community as a whole. In this light, the free NHS policy shows the concern for the greatest majority in the individual since not everyone can access the medical services due to reasons such as poverty and discrimination.
The communitarianism approach in the medical sector emphasises the building of moral commitments within the institutional and social structures to enhance the relationship between the medical experts and the patients. The issue of access controls as manifested in the case of “health tourists’ unearths the absence of moral commitments between the patient and the healthcare professional. Therefore, for the nourishment of care in the health sector, there is a need to put the interest of the entire community first. In this respect, the maintenance of equilibrium in the delivery of services by the NHS implies that it needs to combat the issue of self-centeredness based on the ideals of communitarianism.
Importantly, communitarianism in the deployment of free NHS services infers to the realisation of equilibrium between social responsibility and individual rights. Thus, the NHS would do what is necessary to secure the objectives of the proposed policy as well as offering high-quality services to the community members. In this regard, the NHS needs to understand that the community also anticipates the services to meet the unique needs of the individuals that make up the whole.
Moreover, communitarianism underscores that institutions like the ones in the healthcare sector need to uphold their legitimacy of contributing positively to the well-being of the people. Thus, maintaining the balance is important for the success of the free NHS policy in a sector characterised by individualism and discrimination to a considerable extent.
Considerably, communitarianism in the health care sector system fosters the protection of its moral integrity and authentic character. In this regard, the factors that lead to the access controls problem in the NHS system including managerial imperativeness and the commercialisation of public services should be alleviated. As such, the careful drafting of the NHS policy focuses on eliminating such issues, thereby reducing the flaws that deny the entire UK communities the access to healthcare services. Hence, the incorporation of communitarianism in the UK health sector would lead to the prevalence of ethical practices that would improve the unique image of the NHS besides as the oldest single-unit healthcare body in the world.
Recommendations
The success of the proposed NHS policy is crucial for the improvement of the health and social welfare aspects of the UK society. However, the identified issues that trigger the access control problem in the NHS system should be mitigated to enhance its performance. Thus, considering the following remedies is important for the accomplishment of accessible medical services in states such as Scotland.
The policy needs to embrace the priority approach to healthcare service offering. The traditional pricing mechanism needs abandonment to clear the long waiting lists that reveal the access controls problem in the NHS system. In doing so, the shift towards the establishment of entirely free medical services in the UK focus on a new approach that prioritises needs instead of one’s background.
The development of a health sector characterised by competitiveness amid the provision of free services is also essential for quality improvement. However, the political interference aspect needs limitation to cultivate the development of a free market economy. The public-private partnership would also hold water in this case.
The policy also needs to concentrate on addressing the various forms of inequalities experienced by women in the provision of medical services. The NHS needs to identify and empower disadvantaged women such as the poor, the disabled, and the elderly to guarantee they access health services equally. The move would eliminate the gendered aspect of social exclusion regarding healthcare in the UK.
Moreover, the NHS policy ought to integrate the responsibility, integrity, and morality elements of service delivery. In doing so, the system would get rid of the individualism approach to service delivery by concentrating of the well-being of the community as a whole. Furthermore, in doing so, the NHS policy would assume more responsibility in delivering their services in a transparent manner, and, thus, improve their image in the UK.
Reference List
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Cox, R 2001, ‘The social construction of an imperative: why welfare reform happened in Denmark and the Netherlands but not in Germany’, World Politics, vol. 53, no. 3, pp. 463-98.
Fitzpatrick, T 2005, New Theories of Welfare, Palgrave, Basingstoke.
Lister, R 2010, Understanding Theories & Concepts in Social Policy, Policy Press, Bristol.
NHS: Five-year forward review 2014. Web.
O’Brien, M & Penna, S 1998, Theorising Welfare, Sage, London.
Spicker, P 2014, Social Policy Theory & Practice, 3rd edn, Policy Press, Bristol.
Taylor, G 2007, Ideology and Welfare, Palgrave Macmillan, Basingstoke.