Updated: Oct 31st, 2024

Steer, Not Row Concept of Healthcare Policy Essay

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The so-called ‘steer, not row’ approach to defining the conceptual essence of governmental policies, with respect to healthcare, in general, and to the cared-for children and vulnerable adults, in particular, is concerned with the ideology of Neoliberalism, the adherents of which have been put in charge of policy-making in most Western countries ever since the late eighties. This ideology refuses to recognize the role of the clearly societal factors on people’s continual ability to enjoy the ‘fruits of civilization’ while proposing that the task of ensuring the continuation of socio-economic progress is the prerogative of what Neoliberals refer to as the ‘invisible hand of the market’. Hence, the foremost discursive implication of the mentioned approach – the government should refrain from assuming too many responsibilities, within the context of enacting a particular social care policy and ensuring that the associated services are properly delivered to the targeted population (McQueen par. 2). Instead, it should delegate the delivering function to the privately-owned companies and limit its involvement in the process – this is what ‘steering’ is all about (Lister par. 5).

The passing of the Health and Social Care Act by the Parliament in 2012, which resulted in the reorganization of the very operational paradigm of this country’s healthcare system, can be thought of as the most recent epitome of the ‘steer, not row’ principle being applied on an all-national level (Abrahams par. 4). According to the Act, it is no longer the responsibility of the Secretary of State for Health to manage the qualitative dynamics in the domain of British healthcare – the concerned task has been entrusted to the so-called ‘clinical commissioning groups’, consisting of general practitioners (GPs) and representing the interests of the pharmacological industry (Miller par. 1). While in charge of implementing healthcare policies, approved by the government, the ‘clinical commissioning groups’ are expected to make sure that, throughout the course of being implemented, these policies never cease to remain economically feasible (Egerton par. 3). As Richards noted, “The government… made it compulsory for the new local commissioning bodies – clinical commissioning groups – to use market mechanisms to commission health services” (par. 1). In theory, the adoption of the ‘steer, not row’ principle for policy-making was supposed to increase the cost-effectiveness of many of the currently available welfare services in this country. The rationale behind the theoretical assumption at stake is that, as Bloom pointed out, “Society has changed in many ways, but the government has not kept up. In the fast-changing communications era, one-size-fits-all and top-down government increasingly fails… A modern society needs a modern government that embraces technology and the private sector to achieve aims that benefit everyone” (par. 9). However, there is plenty of evidence, as to the fact that the continued privatization of the public sphere is strongly detrimental to the interests of society, as a whole.

To illustrate the validity of this suggestion even further, we can refer to how the adoption of the concerned principle has been affecting the well-being of physically and mentally disabled people in this country since the eighties – the time when the ideology of Neoliberalism began to define the ways of the country’s governmental officials. After all, it was back then that the rationale behind policy-making, with respect to disabled adults, has undergone a qualitative transformation. Whereas prior to the development in question, such individuals used to be encouraged to adopt a socially integrated lifestyle, in order to be considered the society’s productive members, by the late eighties/early nineties this effectively ceased to be the case. The reason for this had to do with the fact that, while remaining committed to the ‘steer, not row’ principle, the liberally-minded governmental officials (both, Conservatives and Labourites) proceeded to promote the idea that one’s disability accounts for the concerned person’s ‘uniqueness’ and, therefore, deserves to be ‘celebrated’ – even if he or she leads a socially withdrawn (non-contributive) existence. Hence, the three principal characteristics of the government’s approach to designing social-service policies throughout the course of the last two decades:

Direct cash payments to disabled citizens. The year 1988 saw the establishment of the so-called Independent Living Fund, the main task of which was to distribute money among the disabled (Hawkins par. 3). The concerned development correlated perfectly well with the Neoliberal assumption that consumption is the solemn purpose of one’s existence and that to make handicapped citizens happier, they must be helped financially. The passing of the Direct Payments Act in1996, which expanded even further the number of the would-be qualified recipients of ‘disability payments’, was also meant to promote the continual commercialization of the healthcare sector in the UK. According to Mercer and Barnes: “By the mid-1990s, the Conservative Government was finally persuaded that cash payments fitted with its agenda to promote market competition and individual choice” (7). The actual intention behind the initiative was well-meaning – to allow disabled individuals to take a better care of their health-related needs and to deinstitutionalize the country’s welfare-policies to an extent, as the foremost precondition of increasing the measure of their cost-efficiency (Humber par. 15). However, the actual outcome of the initiative’s implementation turned out to be much different from what it was expected to be. After all, it did not only result in the dramatic rise in the number of disability-claimants across the nation, but also in making it much harder for the disabled to achieve recovery/betterment (Heslop 5). The reason for this is apparent – after having realized themselves in the position to claim cash on the account of their ‘uniqueness’, the qualified citizens ended up being naturally prompted to yield to their consumerist instincts, which made it even harder for the concerned individuals to be able to stay on the course of betterment. Therefore, there is nothing surprising about the fact that that, ever since the time of both mentioned developments, there appears to have been an exponential momentum to the rise of disability claims across the UK – something that undermines the overall effectiveness of the country’s healthcare system (Banks, Blundell and Emmerson par. 4).
Decentralization. As it was mentioned earlier, the Neoliberal paradigm of healthcare presupposes that, the less there is top-controlled orderliness to the delivery of social services to the disabled, the better. This explains the actual logic behind the ongoing process of these services becoming ever more ‘localized’, in the sense that the task of providing disabled adults with social services is increasingly entrusted to the communal authorities (Edmiston par. 3). The process’s initial phase can be traced back to the adoption of the Chronically Sick and Disabled Persons Act (CSDA) in 1970, which put the municipal authorities in charge of ensuring the adequate quality of housing conditions for the disabled (Griffin par. 12; Broach par. 7). Nevertheless, as time goes on, the initiative’s counter-productiveness becomes apparent to more and more people. There are two reasons for this: 1. As practice shows, the manner in which local authorities address their CSDA-related obligations is mostly concerned with hiring more and more social workers, who are supposed to alleviate the suffering of people with disabilities – something that local authorities tend to perceive as such that has the value of a ‘thing in itself’. Ironically enough, this fosters the bureaucratization/formalization of health-services for the disabled, which is hardly beneficial for the latter. 2. The very notion of ‘incapacitating disability’ suggests that there are long-term effects on the affected person. Consequently, this implies that it is specifically the highly trained professionals who should be in charge of prescribing him or her with the rehabilitative therapy. However, the communal approach to dealing with disabled people often implies the reduced quality of the would-be delivered social services, by definition.
An introduction of new/additional charges for social services. This particular effect of the utilization of ‘steer, not row’ approach has been brought about by the fact that, as of today, private sector providers are in the position to have an active voice within the NHS, as the Organization’s stake-holding subsidizers. As a result, they demand from the NHS to take into the consideration their own corporate interests, within the context of how the Organization goes about setting up its policies for the disabled. This simply could not be otherwise, as it is in the very nature of private sector providers to prioritize making money above everything else, It is understood, of course, that this may hardly have any positive effect on the concerned category of people, as those who have been traditionally considered the most socially unprivileged of all (Dykes par. 1).

In light of what has been said earlier, the ‘steer, not row’ approach cannot be deemed thoroughly appropriate, when it comes to designing policies, meant to be taken advantage of by the disabled. Apparently, the promoters of such an approach do not understand the systemic nature of the interrelationship between the society’s integral elements – hence, their insistence that the domain of social services should be commercialized. This idea is based on the assumption that while seeking to receive high-quality social services, disabled people never cease to remain socially alienated in one way or another – hence, these people’s supposed preoccupation with trying to qualify for as many welfare-payments, as possible (Browne par. 1; Wood, par. 8). This point of view, however, ignores the fact that it is in the very nature of people to aspire for the socially sound ways of self-actualization – regardless of what happened to the nature of their disability. It is not such physical or mental disability that the affected individuals want to celebrate, but their ability to overcome it – something that can only be achieved if the government actively ‘rows’ to address these people’s needs.

Therefore, it will only be logical to conclude this paper by reinstating once again that the ‘steer, not row’ approach to dealing with disabled citizens is certainly not the best. While claiming that it is the other way around, the approach’s advocates strive to conceal their actual agenda – to treat such citizens as a ‘social burden’ (giving them some money and forgetting about them) which in turn is supposed to revitalize the functioning the country’s free-market economy (Daley par. 11). However, despite the presumed soundness of the approach, the idea of ‘steering and not rowing’ in the social domain is synonymous with the idea of the state refusing to address its statehood-functions – something that may never prove justified in the long term.

The importance of ensuring confidentiality in health and social care cannot be underestimated, as it represents the foremost functioning principle of the Health and Social Care Information Centre (HSCIC). In its turn, this can be explained by the highly sensitive nature of the data, processed at HSCIC on a daily basis. After all, in order to qualify for a particular social service, an individual is commonly asked to disclose much personal information, such as the history of past illnesses, on his or her part. As of today, social workers are expected to observe the following five major rules while on the line of addressing their professional responsibilities: 1. Confidential information must be handled in the highly responsible manner. 2. If this type of information is to be used in social research, it must be anonymized prior to being made available to researchers 3. In cases when the release of confidential information is deemed to be in the client’s best interests, he or she (or the person’s legal guardians) must be approached with the request for consent. 4. Social workers are there to safeguard sensitive information from any attempts to be assessed by a third party – unless ordered to act otherwise by the court. 5. Social workers are in the position to share confidential information with each other if this will benefit the concerned clients.

Thus, the mentioned rules are best seen as such that provide social workers with the methodological framework for handling confidential information. Moreover, this framework is flexible enough to allow such workers a certain degree of autonomy while striving to ensure that their decisions, on managing one’s personal data as a recipient of social services, are circumstantially sound. This, in turn, is supposed to contribute to the functional integrity of the HSCIC.