This article aims to explore the changes and developments in the health and social care in

the UK over the past 30 years (mostly from a managerial and administrative perspective). As
I discuss these changes the article aims to discover the decade in which the most significant
health and social care reforms took place and how they affect us till today. The catalysts
that brought about these changes in both health and social care are briefly discussed when
necessary and their respective outcomes are reviewed. In the process I try to find that fine
line which differentiates health from social care, if such a distinction really is possible, if one
can be independent of the other and which of the two has been in the limelight for the most
part three decades. Based on my research various opinions on these changes in the UK
social and health care mentioned.

This paper is divided into 3 major sections with the first about the 1980’s the second
1990’s and lastly the ‘new ‘millennium till present (2000-2010). This article will review the
various arguments per decade and discover which of them the revolution of the status quo
of health and social care (especially the NHS) policies took place.

In the mixed economy of welfare in the UK social care has largely been provided by the local
governments and voluntary organisations while the National Health Service (NHS) is the
central umbrella for public health care. Since the inception of the NHS in 1948 its primary
goal is to provide medical assistance and improve health. However the ideology of a state of
good health has changed since then and so has the NHS. W.H.O defines health as ‘a state of
complete physical, mental and social well-being of an individual and not merely the absence
of disease or infirmity’, and based on said definition the duties of the NHS extend far beyond
acute medical care services or does it? Thus changes in the administrative structure of NHS
and social care services has been plagued by an ‘identity crisis’ since the 1980’s to make a
distinction as to what the duties of the NHS and the social care providers are.

In the 1980’s the NHS seemed to go through a two drastic evolutional phases within
the decade as most of the administrative policies put in place by the Conservative
government of the early 80’s were abolished by the Labour reforms that followed later in
the decade. According to Powell (p.91) there was a shift to a more general management
style of both the NHS and social care bodies early in the decade. This plan sought to improve
efficiency “through the creation of clear managerial hierarchy” (Powell p.91). Around this
time the importance of an efficient healthcare system in the UK was undermining need for
improvement of social care. The wall separating the NHS and the social care sector was
fortified as more government funds were allocated to the NHS from the social security
budget with little thought for the social care services; an often overlooked constant which
must be present if the formula for the solution of the ‘perfect’ healthcare plan is to be
realized. This is due to the fact that the government obviously had difficulties clearly
defining the roles of health and social care are to play in the society. Eventually, the
Department of Health declared that for some individual cases it was impossible to make a
clear distinction between the needs of an individual for health and for social care. Some
medical cases were “intermediate” and could not be associated with one or the other.
Despite this it was clear that the local politicians considered other priorities more pressing
than social care. Less funding for social care services meant more responsibilities on the
NHS. This did not solve the problem of the increase of the number of patients like the
elderly and mental patients who required maintenance and not acute care. According to
(Jane, 347) the obvious solution was the provision of rehabilitation facilities to provide more
domiciliary care. In general, the market orientation and scope of the NHS was below par at
the time.

The Conservative Healthcare policies of the late 80’s sought to, in theory, bring forth a
‘new’ NHS. The importance for a more consumer-oriented healthcare system was the
epicentre of the new reforms. Following this paradigm shift surveys were carried out by
local authorities to find out what people wanted their ideal NHS to be. Assessing the service
quality of health and social care service provided would be based on consumer satisfaction
and less on spending and budgets. For this plan to be a success the NHS and the social care
sector had to work hand-in-hand. Plans were put into place to promote efficiency through
competition. Health and social care institutions like the NHS Trust and General Practitioner
Fund Holding were made to facilitate this. It seemed like the primary objective of all this
was to split the NHS into efficient and competitive units as this is the driving force of the
high levels of efficiency shown by the private enterprises in the economy. This competitive
drive would make the NHS more goal-oriented as the scope of the NHS, being a casualty of
political tussles, seemed to have retired into the background.

The Conservative reforms of the NHS were very prominent well into the 1990s. The NHS
continued to function alongside the social care providers as a more consumer-oriented body
with some changes in both managerial and administrative styles that soon followed. The
introduction of the quasi-markets into health and social care with a NHS and Community
Care Act was induced in 1990. With the influence of the local authorities, the NHS started
campaigns to create awareness to help the populace know how to reduce the risk of
suffering from certain diseases (Powell). This was all part of the Conservative ‘Health of the
Nation’ strategy. Surprisingly, the first time targets for improving general health had been
clearly set in a formal way.

The NHS under the Labour government elected in 1997 saw an increase in trusts and
trade unions within the health and social care sectors. The influence of trade unions in
decision-making within the NHS was very prominent at this time (Horton,407). Partnerships
agreements spread faster in the public sectors as advancements in communication
technology like the internet made frequent communication less of a hassle. The NHS wasted
little time in capitalising on this and NHS Direct was instated. This provided 24-hour medical
advice to whoever called and had ambulances at the ready in case of any life-threatening
medical emergencies reported. Locally agreed Health Improvement Programmes conducted
by the Local communities but managed mostly by the NHS executives were commonplace.
Generally, the competition ethic was replaced by collaboration and partnership within the
health and social care sector. However did this not abolish the problems of the intermediate
group was-ever present especially after a (failed) attempt to clarify the responsibilities of
health and social care services in the year 1995. New medical technologies meant that
length of stay shortened by 40 percent; most patients in need of continuous care could be
taken care of at home. Thus there was much uncertainty as to if the provision of the
‘intermediate’ care required was the responsibility of the health or social care providers
(Jane356). The Department of health having concluded that intermediate care encompasses
both health and social care decided that policies aimed to promote “major expansion of
social care (and health services) to help cure and maintain people in their home
communities.

It seemed that finally the government began to realize that unlike the NHS the ‘value’ of
social care could not the quantified in terms of budget allocations.

The new millennium brought about some new reforms and changes of its own.
Following the success of the reforms of the previous decade some of the changes made in
HSC seemed to be an extension or improvement variation of the reforms of the late 1990s.
The major concern of the government seemed to shift toward the improvement of both
health and social care sectors together and not mostly the NHS as has been the norm for
quite some time.

Plans were put into action to promote the efficiency of the health and social care sectors by
the continuous use of market tools to promote equity in the provision of health and social
care. As () said “Patient choice became a lynchpin of the UK governments current health
policy”. The general idea seems to be the use of consumer equality schemes to bridge the
divide between the health and social care sector. Thus the government decided that be best
way to improve on the success of the 1990s is to promote patient choice. Health and social
care being public services is entitled to all in the UK. Emphasis on consumer choice would
make the people feel influential and in control as would a consumer who is paying for a
product or service. Questionnaires were handed out by local authorities to figure out what
people would like to see changed in their local hospitals and social service providers. This
aimed at insuring a paradigm shift of the NHS; people would be more satisfied with the
services they get because they had a significant influence in the change. This whole idea
though brilliant was more of a hit-or-miss affair. No matter how many administrative
changes made access to health and social care services is dependent on income, areas and
social class. Differences in class plague each and every consumer’s perception of health and
social care.

This is the primary cause of a change in managerial styles within the health and social care
sector; starting 2002 a ‘bottom-up’ approach was used as opposed to the usual ‘top-down’
methods(). The government began to realize policy is nothing but an idea if not put into
action by the people who wonk hand-in-hand with the consumers on a daily basis. In the
year 2000 more Primary Care Trusts (PCT) launched in England; this strategy was another
way to promote collaboration GPs and the social care providers. These were made to
provide new single multi-purpose legal bodies responsible for the health and social care
needs of their allocated region.