Creating a Welfare State (1918-1979) PDF

Britain transformed, 1918-97 1.2 Creating a welfare state, 1918-79 Key Questions How successfully did British governments provide welfare support in the years 1918-79? Why, and with what impact, was the National Health Service created in 1948? To what exten...

Britain transformed, 1918-97 1.2 Creating a welfare state, 1918-79 Key Questions How successfully did British governments provide welfare support in the years 1918-79? Why, and with what impact, was the National Health Service created in 1948? To what extent has educational reform led to widening opportunities? Between 1918 and 1951 successive governments created a comprehensive welfare state. Building on the foundations laid by reforming governments prior to the First World War, governments in the 1920s and the 1930s began building new welfare institutions. While the political parties disagreed over the extent of welfare provision, following 1918 there was a new consensus. It was widely agreed that government had a duty to provide welfare in terms of unemployment benefit, some kind of healthcare and education. Put another way, welfare was perceived as a right, an entitlement for British workers. The 1945-51 Labour government took welfare provision to another level. Keen not to repeat the mass unemployment and widespread poverty that followed the First World War, Labour ministers introduced comprehensive welfare provision, designed to support British workers from the cradle to the grave. The National Health Service was, perhaps, the most radical aspect of Labour’s welfare state. It provided world- class healthcare to all in need and was free at the point of delivery. Labour’s welfare state was supported by all mainstream politicians during the 1950sand 1960s. However, in the early 1970s the political consensus began to break down. Politicians associated with the New Right argued that social welfare, including unemployment benefit, trapped people in a culture of dependency. Moreover, they argued that growing welfare bills were diverting resources from economic growth and therefore undermining Britain’s long-term economic performance. There was concerns that hospitals were poorly managed and that education was failing to equip and discipline students. Introduction  Welfare: the aid given in the form of money/necessities to those in need, usually the old, the young, the sick and the poor.  The first three groups were viewed as ‘deserving’ poor = cared for by relatives, the Church, private organizations and increasingly the state.  However, until the end of the 19th century, healthy people of working age who fell into poverty were often seen as morally at fault and, therefore, ‘undeserving’ poor  The process of having to prove that you ‘deserved’ welfare was a hated, humiliating experience.  1908: the Liberal government inaugurated a huge expansion of state-provided welfare. These new support mechanisms were open to all who qualified, with no distinction between ‘deserving’ and ‘undeserving’ poor.  However, the new liberal reforms weren't universal; pensions were only offered to the poorest people and unemployment insurance was only available for 15 weeks a year to workers in 6 industries. For those without insurance, the only option was to fall back on older forms of welfare provision.  The situation in 1918 at the close of WW1 cannot be described as a ‘welfare state’ (where universal support is available to anyone: ’from cradle to grave’, it had been described as a ‘social service state’ (where a minimum of support was offered toothless without independent means of survival)  Although WW1 generated desire and opportunity to create something approaching a welfare state (best known by the creation of a Ministry of Reconstruction in 1917), the arrival of economic problems after 1920 undermined such hopes and plans. 1  The adoption of Keynesian economic theories, and a determination to avoid the broken promises made after the Great War, meant that WW2 caused a comprehensive shift in welfare provision. The Attlee government spearheaded a welfare revolution, with the NHS as ‘the jewel of the crown’.  However, even as the welfare state was being forged, there were concerns over the cost and the effect that such universal provision would have on people’s moral compass and independence.  1979: An increasingly large and expensive system, these concerns had developed into criticisms. While the welfare state continued to have many supporters (not least the huge numbers of people who gained employment or effective support from it), these criticisms only grew as Britain headed into the 21st century. How successfully did British governments provide welfare support in the years 1918-79? This chapter explores the extent of social welfare provision in Britain in the twentieth century and the factors that influenced it through the following sections:  The extent and nature of welfare provision, 1918-39  The impact of the Second World War, the Labour Government and consensus, 1939-64  Reasons for increasing challenges to welfare state provision, 1964-79 The extent and nature of welfare provision, 1918-39 Unemployment  The biggest problem for interwar government: this was never below 1 million (about 10% of the workforce) between the end of 1920 and mid-1940, and peaked at over 3 million in the early 1930s.  Interwar governments wanted to support the unemployed, but also wanted to balance the books.  1911 National Insurance Act = A self-funding National Insurance scheme, with benefits paid from a fund generated by members’ contributions whilst employed, was seen as the ideal solution  The Poor Laws: (1500s-1948) were a system of relief for the poor set up during the rule of the Tudor dynasty in the 16th century. The Poor Laws made a clear distinction between the ‘deserving’ poor and the ‘undeserving’ poor: the former were given food, clothing and sometimes housing or money paid for by local rates, while the others were often punished as criminal beggars.  However, the war undermined this scheme = many of the 3.5 million returning troops were not eligible for the benefits it provided = they had not worked in one of the specified industries/they had not made sufficient contributions.  The wartime coalition realized that a difficult situation was developing: it would take time to redesign the National Insurance scheme but, in the meantime, men who had fought for king and country count not be left to rely on the old Poor Law. = The only alternative was to hand out dole money. As this would be paid out of general taxation (or borrowing) with no link to individual contributions, it was feared that this would upset the budget, divert funds from more productive use and encourage reliance on unearned income.  The short-term solution was to issue dole money but under a different name: the ‘out-of-work donation’ (1918-20) was issued to returning troops and the civilian unemployed until they found work. Although it was meant to be temporary, it set two important precedents: the government accepted a duty to adequately support the unemployed, regardless of insurance contributions; and it provided more money for family dependents.  At the same time, a new Unemployment Insurance Act 1920 was developed to offer a longer-term solution. The idea was that increasing the number of workers covered by insurance would make the scheme self-funding. Unfortunately, the Act was passed in 1920, just as the effects of the post-war slump were beginning to bite: rather than create a self-funding scheme, the greater number of eligible claimants (around 2/3 of all workers) quickly drained the funds.  1921: the government was forced to make ‘extended’ payments; these were meant to be paid for through worker contributions from future employment but were, in reality, dole payments disguised as insurance. The government chose to make these payments because the Poor Law could not cope with the scale of the problem and the ministers feared a revolution if they were not properly supported. The government was already feeling pressured as 2.4 million workers had taken part in strikes over pay and conditions in 1919. However, attempts were made to limit the expense of the new system: a 2  ‘seeking work test’ was implemented in March 1921; by March 1930, 3 million claims had been rejected because of the test.  Major changes in the provision of welfare for the unemployed were enforced through the 1929 Local Government Act and the 1934 Unemployment Act. The Local Government Act said that county and borough councils had to set up Public Assistance Committees (PACs): These were centrally funded and replaced the Poor Law Guardians who had administered funds under the old Poor Law. In response to the financial crisis of 1931, the PACs were given the power to means-test claimants: their combined household income was thoroughly investigated to judge eligibility for dole payments. The means test was hated: not only was it an invasion of privacy, it was also unfair, as some PAC’s were less stringent with their tests than others. By the end of 1931, 400,000 people had been rejected or reduced claims because of their test.  The Unemployment Act separated the treatment of ‘insurable’ from long-term unemployment. Part 1 of the Act provided 26 weeks of benefit payments to the 14.5 million workers who paid into the scheme. Pat 2 created a national Unemployment Assistance Board (UAB) to help those with no entitlement to insurance benefits.  1937 = the UAB had assisted 1 million people on a national means-tested basis. By this point, Poor Law provision had shrunk to just a few groups not covered by the UAB; these included widows, who could not yet claim a pension, and deserted wives.  The government had not been able to solve unemployment, largely because the existing wisdom of retrenchment (spending cuts and tax rises) could not stimulate economic growth.  It was only when huge state spending was poured into rearmament after 1936 that persistent unemployment was finally tackled.  Although the focus here had been on government efforts to create a level of unemployment welfare acceptable to both the treasury and those without work, the human impact of mass unemployment should not be forgotten.  Historian Derek Fraser has written, ‘Unemployment…had poisoned millions of homes, it had blighted whole industrial regions; it had disinherited a generation; and it had laid low an elected government’. Pensions:  State pensions had been introduced by the 1908 Pensions Act.  Although they were hugely popular with the eligible over-70s (poor men and women who had worked throughout their lives and lived in the UK for 20 years), there were criticism that they were means- tested and did not support the widows and children of the deceased.  Minister of Health, Neville Chamberlain, addressed these concerns with his 1925 Widows’, Orphans’ and Old Age Contributory Pensions Act. This provided a pension of 10 shillings a week for those aged 65-70, and provided for widow and their children and orphans. It was funded by a compulsory contribution (individuals, employers, and the state paid into the Labour Party, who felt it unfairly penalized the poor but the tough economic conditions, together with an ageing population, led to a general acceptance. Self-employed workers of both sex were allowed to join the scheme in 1937.  The lack of improving with pension provision compared to employment payments could suggest what a good job Chamberlain did in drafting the 1925 Pensions Act. It is more likely that this reflects the enormous pressure placed on interwar governments by unemployment and the limited options they saw available to deal with the problem. Housing:  Local and national government had made efforts to improve housing since the mid-Victorian era.  There was a concern that slums promoted crime and disease and a lot of slum clearance had been undertaken before 1918.  A major improvement in urban living standards was achieved by the introduction of mains water and sewage to homes: as late as 1899, only 1/4 of houses in Manchester had flushing toilets compared to 98% by 1914.  The government had promised returning soldiers ‘a home for heroes’ and the 1919 Housing and Town Planning Act aimed to empower local authorities to use central government funds to meet housing needs.  Estimated that over 600,000 houses would have to be built to meet demand, only 213,000 were constructed before the onset of recession led to the ‘Geddes Axe’ (The Geddes Axe was the drive for 3  public economy and retrenchment in UK government expenditure) = housing shortage grew worse. One consequence was that young married couples had to live with their parents. The impact of the Second World War, the Labour Government and consensus, 1939-64 The impact of ‘total war’ on social welfare provision:  WW2 led to a wide consensus that welfare provision needed a radical overhaul: A ‘total war’ that affected rich and poor alike, prompted ‘total solutions’ such as universal rationing. The success of such policies gave a boost to Universalist.  The success of a state-directed war economy increased political and popular belief in the potential of state intervention to improve people’s lives after the war. The war forced Britain to borrow large sums of money in pursuit of victory.  The war forced a coalition government: the inclusion of Labour minsters such as Attlee and Bevin led to a great deal of co-operation over wartime policy. The Beveridge Report (December 1942)  William Beveridge was a Liberal politician  He took great interest in social reform  In June 1941, he was appointed to head a government committee to investigate welfare provision, appointed by Churchill.  His key recommendations:  For the state to tackle the 5 ‘giants’ of want (through national insurance), disease (through NHS), ignorance (through better education), squalor (through rehousing) and idleness (through the maintenance of full employment’.  For the provision of state welfare to be centralized, regulated and systematically organized.  For state welfare to be funded entirely by a compulsory single insurance payment; he did not anticipate extra government spending on welfare under his scheme.  His report was popular, it sold 635,000 copies. How far did Labour deliver on its promise to implement the Beverage Report?  The report was practically accepted by Attlee’s government however Labour rejected his call to welfare payments to be met solely by universal insurance.  As contributions were compulsory to be set at a level affordable by the lowest paid; it was felt that a higher rate would penalize the poor as it took a greater proportion of their earnings.  Social security was therefore not introduced on a self-funding basis: higher taxation was used to supplement higher pension and unemployment benefits than those advocated by Beveridge. He was critical of the ‘pay-as-you-go’ method.  However, Labour did implement these key ideas from Beveridge:  The Family Allowances Act 1945 - provided mothers with a non-means-tested payment of 5 shillings a week for each child apart from her first.  The National insurance Act 1946 - created a compulsory universal contributory system to help pay for pensions  The Industrial Accidents Act 1948 - additional cover to workplace injuries  The National Assistance Act 1949 - provide financial help to the most vulnerable poor, such as single mothers, the blind and deaf, who had not been covered by the 1946 Insurance Act. Reasons for increasing challenges to welfare state provision, 1964-79 Why was welfare provision being challenged by 1979?  Criticisms grew on the right wing over the cost and impact of the more generous benefits.  Whereas the left wing still believed they weren't doing enough to help the poorest. 4  The cost of unemployment benefits rose from 0.6% of GNP in 1939 to 5.6% in 1950 and 8.8% in 1970.  However, the level of spending rose just as much under Conservative government:  Baby booms - in the late 1940s and 1950s = more care and education costs for children  An increase in average life expectancy - Between 1941 and 1970, from 64 to 74 for women and 59 to 69 for men = more care for the elderly  New social groups in need of support emerged who had not been considered before = low wage- earning families and lone-parent families  Higher standards of living in general = demands for a higher minimum standard of life for the poorest  The growing size of the welfare state required ever more bureaucracy to make it work.  Margaret Thatcher was a key critic, opposing increase in benefit payments because they encourage a culture of dependence (the poverty trap) and diverted funds away for wealth generations.  Critics on the left were angry about the persistence privilege in healthcare and education. Argues that the state had to do more to ensure that people received a fairer level of support to enable them to live decent lives.  Although there were criticisms of social welfare provision on the left and right, there was enough consensus in the broad middle ground between Labour and Conservatives to ensure that there was no major overhauls of the system until the 1980s.  Financial pressure limited Labour’s generosity while the electoral popularity of welfare provision limited Conservative cuts: Aneurin Bevan and Harold Wilson resigned over Labour’s introduction of charges for spectacles and dentures in 1951, while Conservative Chancellor Peter Thorneycroft resigned in 1958 when his calls for savage cuts in welfare spending were rejected. Chapter Summary  By 1918 governments accepted responsibility for a  The post-war Labour government implemented basic level of social security for its citizens based many of the recommendations of the Beveridge on the Victorian Poor Laws and early twentieth- Report to create a welfare state caring for century legislation. citizens ‘from the cradle to the grave’.  Measures were strengthened in the 1920s through  Although there was broad consensus on the developments in unemployment insurance. desire for the welfare state, critics began to  The Great Depression led to greater demands for question its cost as economic conditions welfare provision which governments could not worsened during the 1960s. afford; one response was the introduction of the  Welfare spending continued to increase, means test. however, and provision was extended, for  The role of the state was extended during the example by the Conservative Government’s Second World War and measures such as National Insurance Act of 1970. evacuation and rationing helped equalise society,  Increasingly right-wingers challenged the with people feeling they were all making sacrifices welfare provision with arguments on the for the war effort. grounds of cost and the growth of welfare  The Beveridge Report of December 1942 created a dependency. blueprint for extensive social security and welfare. 5 Why, and with what impact, was the National Health Service created in 1948? This chapter examines public health through the following sections:  Health provision, 1918-45  The creation and impact of the NHS, 1945-79  The challenge of medical advances, 1945-79  Before 1911, the extent and quality of medical treatment depended upon the wealth of the individual. While the wealthy could pay for medical treatment in private hospitals and for doctors to treat illness in the comfort of their homes, the poorest often suffered and died after ineffective self-medication.  There were health insurance schemes and these were made affordable for most by local Friendly Societies (Members of a Friendly Society make a small regular payment. When they need financial help (e.g. for illness, unemployment or a funeral) the Friendly Society pays out a lump sum). However, these were unregulated and non-compulsory. In areas where there was no workhouse infirmary to provide a safety net for the sick or injured, the collapse of a local Friendly Society could leave members unable to secure any treatment at all.  The National Insurance Act 1911 improved the solutions for many by providing free medical care and 13 weeks’ sick pay for members. Just as with unemployment benefits, the Act only applied to certain workers and did not cover workers’ families.  The Labour Party argued particularly strongly in favour of greater state provision for healthcare.  The Liberal government was partly persuaded by warnings about ‘national efficiency’.  Britain’s ability to compete economically and militarily with rival powers. But, despite the scale of ill- health uncovered by recruitment for the First World War, there was still a lack of political will to take on the complexity of the healthcare problem or the vested interests of doctors and Friendly Societies, some of which had developed into rich, powerful organizations.  As with social welfare provision, the Second World War shifted political attitudes and people’s expectations about healthcare. Within three years of the end of the war, a National Health Service (NHS) had been established. The founders of the NHS had a huge task on their hands, not only in overcoming vested interests, but in attempting to impose order on the confusing muddle they had inherited.  Despite this, they succeeded in creating a national institution with universal free treatment at the point of service and a prized national treasure that successive post-war governments dared not undermine.  Criticisms did emerge over the presidency of private healthcare and over the management and cost of the NHS. While there were limited NHS reforms in the 1970s, no major overhaul of the system was undertaken until the 1990s. Health provision, 1918-45 A lack of change  Healthcare emerged as an off hybrid of state and private provision in the 19th century, state healthcare was provided by a range of different agencies, including the Poor Law, public health authorities and even education authorities.  The Labour Party had called for a nationally organized health system even before the First World War, but vested interests in the state and private sector meant this remained a distant hope.  The First World War exposed the inadequacies of British healthcare: 41% of men were rated as unfit for combat roles in their medical inspection, while 10% were judged unusable in any military capacity. The treatment of those disabled by the war was a further spur to action.  However, although a Ministry of Health was finally set up in 1919, it lacked authority and political will required to radically change the system: a range of medical services - the School Medical Service and the Factory Health Inspectorate.  A key example of the reluctance to change the system was displayed in 1926 when the Conservative government failed to act on a Royal Commission recommendation to either scrap or reform the health insurance system: Minister for Health, Neville Chamberlain advised that the insurance companies were too powerful a group to take on at a time of financial instability. 6  A few big insurance companies, such as the Prudential, dealt with around 75% of health insurance, while a large number of much smaller Friendly Societies, set up to help the poor afford basic medical treatment, handled the rest.  While people could take out private health insurance, a good deal of their business came from the state thanks to Part I of the 1911 National Insurance Act: the government relied on ‘Approved Societies’ to collect subscriptions and pay medical costs. By 1937, around 18 million workers were covered by state health insurance.  There were problems, not only with the insurance system, but also with the medical system itself. Some of the Friendly Societies were so small that they could not afford to pay for members’ with no insurance whatsoever. There was also a lot of duplication of roles due to the large number of societies operating in each region. The 1911 Act only insured workers: the wives, widows and children of poor workers remained without a safety net and relied on family, the local community or a sympathetic general practitioner (GP) for treatment without charge.  GP’s were the first option for most medical care; it is for this reason that they are an important part of what is referred to as primary healthcare. Local authorities also provided a range of care services. However, patients would not only have to pay for a consolation, they usually had to pay for the medicines too. In rich areas, GPs could earn a good living. In poor areas, people would only go to the doctor as a last resort and sometimes could not pay for their treatment; GPs could struggle to get by and sometimes had to hire debt collectors to get paid.  When the NHS was finally launched in 1948, doctors were shocked by the sorts of medical issues that poor people had put up with rather than pay for treatment. These included untreated hernias and skin diseases, but more commonly toothache, dental abscesses and rotting teeth, due to the expense of dental treatment.  A further problem was the lack of adequate hospital provision. The very best hospitals were the teaching hospitals. There were 12 of these prestigious voluntary hospitals (a hospital funded by charitable donations) in London and ten in the provinces. Hospitals such as Guy’s in London had a long independent history and trained top specialists and consultants. These attracted generous donations from wealthy donors. The majority of the other 1,000 voluntary hospitals were smaller, staffed by visiting consultants or GPs, and less financially secure: when charity, fees and local authority grants did not cover costs, the hospital could declare itself bankrupt; this ‘shroud waving’ was usually enough to encourage further local donations to avoid closure. As the cost of more advanced medical treatment increased, it was clear that many voluntary hospitals would struggle to stay financially viable. As fees were an important part of their income, they needed a quick turnover of patients; for this reason, they did not admit the elderly or those with chronic illnesses. Such patients were forced to rely on public hospitals.  State-provided hospitals had emerged out of workhouse infirmaries. In some cases, these had become good medical centers, but all too often they were overcrowded with elderly and chronically ill patients.  The 1929 Local Government Act empowered PACs to take over and develop these infirmaries into proper hospitals. However, there was no timetable or compulsion for action and, with a few exceptions, uptake was slow outside of London: in 1939, half of all public hospitals were still Poor Law infirmaries. The government, with their attention on the economy, lacked the political will to enforce change: a national survey of hospitals conducted in 1938 revealed a shortage of beds, building, equipment, trained consultants, and poor patient accessibility due to the poor distribution of good hospitals. As with other welfare developments, the Second World War changed all this. The impact of the Second World War on healthcare  Daniel Fox (historian) emphasized the growing consensus over what should be done about healthcare before 1939, and others such as Paul Addison and Kenneth Morgan have focused on the pioneering role of the post-war Labour government.  War = catalyst for profound change  The prospect of war led to the creation of nationally funded organizations to deal with expected casualties: a national system of blood transfusion depots was established in 1938 near hospitals, but far enough away to avoid bombing; this continued after 1946 as the National Blood Transfusion Service.  More significantly, an Emergency Medical Service was set up in 1939 to treat military personnel and, as the war progressed, a wider range of civilian casualties. National funding for the service led to an impressive growth in the number of beds, operating theatres and specialist treatments available. 7  Example of particular specialisms that emerged included the treatment of severe burns by plastic surgery, of kidney trauma due to the number of crush injuries and of the mending of broken bones.  This successful state response to adversity inspired Beveridge to call for a National Health Service as a vital component of a ‘satisfactory scheme of social security’. His report heavily influenced the 1944 White Paper, ‘A National Health Service’, which in turn formed a significant part of the 1946 National Health Service Act.  Despite the deaths and injuries from fighting and bombing, the health of the average Briton improved during the war thanks to rationing (the rich ate less and the poor ate more) and increased government propaganda to educate people about healthy habits. Beveridge was keen that the NHS should serve as a preventative as well as a curative service. The creation and impact of the NHS, 1945-79 ‘Stuffing their mouths with gold’: getting the doctors onside  Despite the positive experiences of state-funded national health projects during the war, there were still some significant obstacles to overcome and difficult choices to be made in the formation of the NHS.  Attlee chose Aneurin Bevin as his Minister for Health to get the job done. Bevan was determined from the start to create a centrally rather than locally run system, funded by taxation rather than insurance. Succeeded = his political skill and determination and the pressure of public support for change.  The 1946 National Health Service Act = coordinated, centralized system.  The Approved Societies were forced to rely on private clients for business and the voluntary hospitals, apart from the teaching hospitals, were nationalized.  The problem that proved to be most difficult to overcome was doctors’ resistance to working as state employees.  February 1948 = 90 percent of the British Medical Association voted against working within the NHS. Argued = would undermine their clinic independence. In reality = most doctors were more concerned about losing income. Bevan overcame their opposition by granting doctors a fee for each patient on their books, rather than paying them a direct salary, and by allowing consultants to retain private patients; on 5 July 1948, 90 percent of doctors (18,000) joined the NHS, just one month before the launch date.  Bevan was angry that he had only gained doctors’ support by ‘stuffing their mouths with gold.’ A healthy change?  The NHS allowed many Britons to take advantage of global improvements in combating disease through research into new techniques, vaccinations and medicines.  In the first ten years of the NHS, new antibiotic drugs developed in the USA caused the number of deaths from tuberculosis to fall from 25,000 to 5,000 per year.  A Programme of mass immunization led to a huge drop in causes of polio and diphtheria in the mid-1950s.  There was a 90% drop in cases of whooping cough by 1970 and syphilis was almost completely eradicated by the early 1990s.  The MMR (measles, mumps and rubella) vaccine was developed in 1971, in the USA. The NHS began offering the MMR vaccine free of charge in 1988.  Improved midwifery = maternal death in childbirth to fall from one per 1,000 births in 1949 to 0.18 in 1970.  Increased funding for healthcare also helped.  Over 300 inadequate cottage hospitals were closed in the 1960s and new centers of excellence, with close ties to universities, were funded, along with district general hospitals for larger towns.  These changes = increased life expectancy: for men it increased from 66 in 1950 to 70 in 1979 and for women from 71 to 75 in the same period.  However, a range of diseases associated with old age increased due to the greater number of people surviving into their eighth and ninth decade.  Heart disease and cancer increased through the 1950s and 1960s, before lowering in the 1970s due to better diets, more exercise and fewer smokers.  Arthritis continued to be the largest health problem, affecting 200,000 men and 700,000 women in 1970. 8 Aneurin Bevan (1897-1960)  Aneurin Bevan is one of the most celebrated figured in Labour Party history.  Born in South Wales in 1897, Bevan was from a mining family and left school at 13 to work in a colliery.  He soon became a trade union activist, and was able to study in London with sponsorship from the South Wales Miners’ Federation.  When Bevan returned to Wales in 1921 he found work as a union official, in 1926, he became one of the leaders of the General Strike in South Wales, and he was elected MP for Ebbe Vale in 1929.  After Attlee’s victory in the 1945 election, Bevan was appointed Minister of Health and oversaw the foundation of the National Health Service.  After a short stint as Minister of Labour in 1951, Bevan resigned from the government in protest at the then Chancellor Hugh Gaitskell’s decision to introduce charges for prescriptions, dental treatment and spectacles.  The 1950s were marked by division and in-fighting within the Labour Party, and Bevan became the figurehead for the left of the party, known as the ‘Bevanites’ (in contrast to the Gaitskellites). Despite their rivalry, Gaitskell, now party leader, appointed Bevan shadow foreign secretary in 1956, and deputy leader in 1959. Bevan died in 1960. The challenge of medical advances, 1945-79 Dentures and spectacles: the unexpected expense of the NHS  Dentures and spectacles: the unexpected expense of the NHS  Bevan, like Beveridge, had expected the cost of healthcare to fall after 1948. People appeared to be getting healthier and it was also hoped that better access to preventative medicine would reduce the cost of more serious health problems. As the NHS would be so large, it would be able to take advantage of economies of scale (buying things more cheaply in bulk).  NHS cost 4.1% of GNP in 1950  NHS cost 4.8% of GNP in 1970  NHS cost 14% of GNP in 1990  There were several reasons for this increased expense:  Advances in medical science = increase in treatments available, sometimes for illnesses that were incurable or had not even been recognized in 1948. In 1948, only one antibiotic was available; by 1968 there were 33.  Advances = higher public expectations and demands of healthcare. People came to depend on the NHS. He had hoped that voluntary helped by families and communities would support the work of medical professionals. Instead, to Bevan’s shock, a ‘dandruff syndrome’ rapidly emerged: people took up valuable time and resources with complaints about the most trivial problems, like dandruff.  Backlog of cases to deal with in 1948, it was difficult to dedicate the necessary time and funds to planning and the full reorganization of the old system. The division of healthcare within regions between general practitioner (GP), hospital specialist and public health authority made the cost- effective coordination of healthcare difficult to achieve.  The number of staff employed by the NHS doubled from 500,000 in 1948 to over one million in 1979.  The increasing cost of the NHS (and the expense of an ongoing war in Korea between 1950 and 1953) caused an argument that led to Bevan’s resignation and contributed to a split in the Labour Party.  In 1951, charges were introduced for dentures and spectacles.  Bevan, and his ‘Bevanite’ supports, felt this undermined the key principle that care should be free for all at the point of service. As the charge was a fixed sum, it penalized the poor more than the rich.  Arguments over the cost and management of the NHS were remarkably persistent after 1951. Medical advances in the 1960s and 1970s  As medical advances were made in the 1960s, the public began to expect more from the NHS.  This contributed towards increased costs, but also led to great improvements in healthcare.  The first kidney transplant took place at Edinburgh Royal Infirmary in 1960. The demand for kidney transplants quickly overtook supply, and kidney failure services reached 2% of the NHS budget in the 1970s, rising to 3% in the 1990s.  The NHS had an impact on changes in wider society with the introduction of the contraceptive pill in 1961. The pill = contributed to female sexual freedom in the 1960s and 1970s (although until 1967 it 9  was only viable to married women). Between 1962 and 1969, the number of women taking the pill on the NHS increased from fewer than 100,000 to over one million. Women now had fewer children, resulting in smaller families.  The Abortion Act 1967 made abortion legal up to 28 weeks into pregnancy, if carried out by a registered doctor and if two doctors testified that it was in the best interests of the women concerned. The post-war ‘baby boom’ was over.  The first full hip replacement was carried out in 1962, and Britain’s first heart transplant took place at the National Heart Hospital in London in 1968. As the first patient died of complications, only six transplanters were carried out between 1968 and 1978, but medical advances made the procedure much safer in the 1980s.  The CT (computerized tomography) scanner was invented in 1972 and became standard equipment for NHS hospitals, thereby contributing to improved patient care but also to increasing costs. Chapter Summary  By 1918 there had been steps to improve people’s  In 1939, the creation of the Emergency Medical health through measures such as the introduction Service laid the foundation of a national health of national health insurance in 1911, but the service during wartime. overall picture was patchy.  In July 1948 the National Health Service was  During the interwar years there was an overall created as available to all and free at the point of consensus that the government should take an delivery; the opposition of powerful medical active role in the provision of healthcare, but groups such as the BMA having been overcome. disagreement as to what forms this should take.  In the post-war era, healthcare and life  The 1929 Local government Act led to the expectancy improved dramatically. reorganisation of healthcare on a regional basis  As provision increased alongside medical with the creation of local health authorities. advances and people’s expectations, costs  The 1930s saw innovations in preventative increased enormously. medicine, for example at the Pioneer Health Centre in Peckham, south London. 10 To what extent has educational reform led to widening opportunity? This chapter examines education and widening opportunities through the following sections:  Education policy, 1918-43  The impact of the Butler Education Act and the Crosland Circular, 1944-79  The growth and social impact of university education, 1918-79 Education in the early 20th century  Provision of formal education was very patchy before it became compulsory - in 1872 in Scotland and 1880 in England and Wales.  Parents were happy for their children to learn from family and the local community before they started paid word. Where schools existed, they were provided by churches, charities and private foundations rather than the state in England and Wales (the state played a larger role in Scotland).  This situation changed from the 1870s when the state plugged gaps in education with new ‘board schools’ and provided funding for older, failing grammar and Church schools. This was partly because the newly enfranchised workers needed some education to use their vote responsibly and because of increasing concerns over ‘national efficiency’.  While private grammar schools and prestigious public schools prepared boys for university entrance, the vast majority of schools provided only an ‘elementary’ education to the age of 11 (or 12 after 1902): children left school with the basic tools of reading, writing, arithmetic and religious instruction, but nothing more.  The 1902 Education Act increased the chances of a grammar school education for able working- class children: in return for state funding, over 1,000 grammar schools offered a quarter of their places to non-fee-paying children who did sufficiently well in entrance exams. Yet, in 1914, only 56 out of every 1,000 elementary school students gained such places. Secondary education remained for the upper and middle classes.  Reform-minded politicians felt it was unfair that the quality and duration of education was so dependent on wealth and class background.  The question was how to provide the most appropriate education for the great mass of working-class children. How far should educational issue be decided locally or at the center? Should schools aim to copy the classical syllabus of the grammar schools or provide more vocational, skills-based lessons? At what age should elementary and secondary education end?  After the Second World War, further questions began to emerge: should schools promote discipline and the acquisition of knowledge or should they be more progressive and promote key skills like group work and self-motivated learning? Should schools promote competition and maximize individual progress or should they promote co-operation and greater social equality? The gender divide before 1918  Was a difference between the curriculum for girls and boys?  In 1904, the Board of Education decided that, within elementary schools, all pupils would study three strands: humanistic and scientific skills along with domestic skills for girls and manual skills for boys.  The idea that boys and girls needed different spheres of education had emerged with the industrial revolution.  Prior to this, when much skilled work took place in the home in ‘cottage industries’ such as weaving, all family members worked and no distinction was made between boys and girls.  With the arrival of factory-based work, men were more likely to leave home in order to find employment, whereas women would perform unpaid domestic work or, if they did need to earn a wage, domestic work for other people as servants. University education before 1918  A number of universities had existed for hundreds of years.  The University of Oxford was teaching students from the early 11th century and Cambridge was founded in 1209. 11  In Scotland, the Universities of St Andrew’s, Glasgow and Aberdeen had been in existence since the 15th century.  Other than the handful of older institutions, no new universities were founded until the 19th century.  Between 1880 and 1909, six new ‘red-brick’ universities were founded in industrial cities, including Sheffield, Leeds, Liverpool and Manchester. Their focus was on providing men with skills they could use in the workplace, especially in the field of engineering.  In 1918, access to university education was limited to those, with the exception of some bursaries or scholarships, from privileged backgrounds, as government funding was still low and widening participation was not a priority. Education policy, 1918-43 The impact of H.A.L Fisher and Sir Henry Hadow  Education reform suffered due to a lack of funding and a lack of political will to act upon sensible ideas.  The 1918 ‘Fisher’ Education Act, named for the President of the Board of Education, H. A. L. Fisher, aimed to help with the construction of a ‘home fit for heroes’. Fisher wanted to widen access to education in three ways: increasing the school-leaving age to 14, providing nursery schools for toddlers and ‘continuation schools’ for new workers aged over 14 to continue their studies for one day a week, and scrapping all fees for elementary education. Although basic elementary education was made free in 1891, there were loopholes that meant that parents could be made to pay for some elements of their child’s education. The Act also made provisions for punishing those who employed school-age children, and provided free, compulsory health checks for secondary school pupils. Unfortunately, few nursery or ‘continuation schools’ were provided due to a lack of funds following the 1922 ‘Geddes Axe’ cuts to government spending.  In 1924, the Labour Minister of Education C. P. Trevelyan, commissioned Sir Henry Hadow to compile a report on how to improve education. The 1926 Hadow Report recommended that elementary schools be placed with primary schools for pupils aged 5 to 11 and three types of secondary schools for those aged 11-15: grammar schools for the most academically able students, technical schools for those who wished to learn a practical trade; and modern schools for the rest. This three-pronged structure was known as the ‘tripartite system’.  While the suggestions were widely accepted, almost nothing was done to act upon the Report: education was not a priority compared to unemployment or, later on rearmament.  Trevelyan tried once again to increase the school-leaving age to 15 under the second Labour government in 1930. This was rejected by the House of Lords on grounds of cost and practicality, but was also opposed by Catholic MPs who spoke for members of their faith who represented having to pay taxes for state schools while also paying fees for educating their children in Catholic schools.  While a minority of Local Education Authorities (LEAs) - (set up in 1902 to replace the old School Boards. They oversaw education within a county or borough. Schools were able to choose whether to receive funding from the LEAs or directly from central government) followed the Board of Education recommendations to set up ‘modern schools’, the proportion of working-class children in secondary education remained fairly unchanged between 1918 and 1943.  As a school leaving age of 15 was not enforced until 1944, children were often found in work in their early teens. The impact of the Butler Education Act and the Crosland Circular, 1944-79 The tripartite system and ‘parity of esteem’  One of the earliest responses to the Beveridge Report was President of the Board of Education R. A. Butler’s 1944 Education Act.  He aimed to tackle the ‘giant’ of ignorance by building upon Hadow’s report.  The school-leaving age was finally increased to 15 in 1947 and secondary education was to be made free and universally available.  To ensure suitable secondary education was provided for all, the LEAs were still left to interpret what ‘suitable’ education meant; most thought Butler was referring to the tripartite model in the Hadow Report. 12  At the heart of the 1944 Act was the 11-plus exam. The exam decided which type of secondary school was ‘more suitable’ for each pupil.  Secondary Technical Schools: these specialised in mechanical and technical education. Very few were established because of the cost of such an education: only around five percent of students, all in towns and cities, attended such schools before 1965  Secondary Modern Schools: these aimed to give a general education to prepare pupils for life and work. 70 percent of pupils went to such schools in the 1950s. Pupils left with a Certificate of Education at the age of 15 and went to work; some also went to Technical College for further vocational education. These schools were sometimes single-sex but more than half took both boys and girls.  Grammar Schools: these provided a highly academic education focused on English literature, ‘classics’ (Latin and ancient Greek) and pure maths. 20 percent of pupils went to grammar schools in the 1950s. At 15, most pupils stayed on for an extra, non-compulsory year and then took exam called O-Levels at 16. Many went on to take A-Levels and some then went on to university. These schools were usually single-sex.  Hoped that a ‘parity of esteem’ would exist between pupils leaving the different types of school.  In reality, the extra funding enjoyed by grammar schools (ironically this era funding was in place to help pupils from poorer backgrounds), together with the shortage of technical schools, meant that the 11-plus came to be seen as a pass/fail test, with those who failed the test condemned to what was regarded as an inferior education at a secondary modern school.  For both boys and girls at junior schools, morning lessons focused on literacy and numeracy, with a broader range of subjects later in the day. Boys and girls continued to do similar core subjects at grammar or secondary modern schools, although there were some differences: girls took subjects such as needlework, home economics and sometimes ‘mothercraft’ at secondary modern schools, while boys did woodwork and metalwork. These differences clearly reflected the different expectations of boys’ and girls’ paths upon leaving school: boys would find a career, while girls would soon settle down to marriage and motherhood. At grammar schools too, there was different expectations and there were variations in the subjects taught. Although all grammar schools had an academic focus, girls were usually encouraged to focus on the arts and language rather than sciences and mathematics. The Crosland Circular (1965)  Between 1960 and 1979, the debate centered on whether comprehensive schools should replace the tripartite system that divided students based on their ability.  Some LEA’s, especially in Coventry, London and Leicestershire, enjoying a great deal of autonomy from central government, had rejected the tripartite system from as early as 1954.  By 1964, 10% of pupils went to comprehensive schools; these accepted pupils of all abilities.  In 1965, the Labour Education Secretary, Anthony Crosland, issued a document known as Circular 10/65, calling for universal comprehensive education. In it he stated, ‘It is the Government’s aim to end selection at eleven plus and to eliminate separatism in secondary education… The Secretary of State requests LEAs, if they have not already done so, to prepare plans for reorganizing secondary education in their areas on comprehensive lines.’  There were arguments for and against such reform and many LEAs looked as if they might ignore Circular 10/65.  In 1966, the government issued another document that said funding for new schools or school refurbishment would only go to LEAs that adopted comprehensive reform; this financial pressure led many LEAs to feel coerced into adopting the new system. Arguments for comprehensive education Arguments against comprehensive education Grammar schools had 2 times the resources of Many grammar schools were excellent and produced secondary modern schools. This did not promote highly successful students ‘parity’ 1960s = many secondary modern schools were already Grammar schools were seen as a precious opportunity for run-down. Comprehensive reform would help many social advancement by many working-class families with children to avoid these poor schools bright children 13 Pupils who failed the 11-plus exam were condemned to 1975 = the government forced direct grant grammar a life of fewer opportunities: only 2% of those who schools to go comprehensive. Many went independent failed the exam were still in school at the age of 17 instead; free places were removed and poorer local parents could not afford these fees The 11-plus favoured middle-class over working-class The rise of more private schools in place of grammar children: very few children from working-class areas schools led to a system that promoted less social equality passed the exam The majority of the public wanted to scrap the 11-plus The majority of the public wanted to keep grammar schools  Momentum for comprehensive education built throughout the 1960s and 1970s. Teachers’ unions and middle-class parents (who feared their children going to secondary moderns if they failed the 11-plus) were especially vocal in their support for comprehensive reform.  The Conservative government (1970-74) removed the Crosland Circular, but did little to stop ongoing reform. Labour’s 1976 Education Act not only reintroduced comprehensive reorganization but removed funding from direct grant schools. Many such schools chose to become independent schools.  By 1979, there were only 150 grammar schools left; whereas only 33 percent of students were educated at comprehensive schools in 1970, this figure had increased to 62 percent by 1974 and 90 percent by 1979. Such rapid change caused much debate at the time and had continued to do so into the 21st century.  Although they enjoyed their autonomy, some LEAs found it difficult to manage the conflicting aims of different head teachers and teachers in their areas. As head teachers had been given a certain amount of autonomy based on trust by the LEAs, they were able to decide how their own curriculum should be taught, particularly in primary schools. As a result, there were sometimes large variations in the way pupils were taught at different schools.  Many teachers began to introduce the progressive reforms championed in the 1967 Plowden Report on primary schools. Lady Plowden reported that, ‘A school is not merely a teaching shop. It must transmit values and attitudes. It is a community in which children learn to live first and foremost as children, to allow them to be themselves and to develop in the way and the pace appropriate to them.’ The ideas contained in the Report were nothing new, as around ten percent of primary schools had already adopted more progressive methods. The progressive reforms referred to in the Report included the following:  There was a large Programme of nursery school building.  More project-based work was carried out at primary schools, rather than teacher-led activities.  There was a focus on learning through play in early years teaching, because of the acceptance that all children learn at a different pace.  The teaching of function and grammar was seen as a hindrance to creativity and a threat to progress.  At some schools, especially in the Inner London Education Authority (ILEA), some liberal teachers and head teachers took such reforms to an extreme: they introduced relaxed discipline, teachers were called by their first name and there was no school uniform. In one school, the William Tyndale Junior School in north London, pupils could choose which classes to attend and watch television or play table tennis if they did not feel like studying. Many parents became concerned about ‘trendy teachers’ and about the lack of discipline and learning in many schools, as teachers in some secondary schools also introduced reforms from the Plowden Report, such as lessons focused on learning through exploration with little teacher direction. Some genuine fears were made worse by a stream of sensationalist stories in the press and by the harsh depiction of comprehensive schools in the hit television show Grange Hill (first screened in 1978).  Pupil’s educational opportunities were more affected by other educational reform than the change to comprehensive education itself.  Only the top 20% of students took O-Levels; the rest left with no qualifications until a new exam called the CSE was introduced in 1965. Pupils at comprehensives were streamed into CSE or O-Level classes. The numbers taking O-Levels remained at 20 percent, but many more students now left with some qualifications. While there was a greater range of subjects for CSE, they were seen as a second- class qualification by employers.  The 1973 Education (Work Experience) Act raised the compulsory school leaving age from 15 to 16. It also allowed LEAs to set up work experience in place of lessons for final-year students. This helped school leaver’s fund work in the tough economic climate of the mid-1970s. 14  More pupils went to university, but this was a result of government funding to boost the number of places available at new universities such as Sussex and Kent. Some universities dropped a requirement for applicants to have O-Level Latin, thereby increasing applications from comprehensive schools where the subject was often not taught. The growth and social impact of university education, 1918-79 Universities before the Robbins Committee Report  The rising number of secondary school pupils, together with growing recognition of the economic value of higher education, enabled the growth of university education in Britain.  Government funding for universities had increased from £1 million in 1919 to over £80 million in 1962.  Between 1920 and 1950, the proportion of university costs met by student fees fell from 1/3 to under 1/8, as bursaries from universities and local councils became more common.  1962 = local authorities were compelled to give an allowance or ‘grant’ to enable students to concentrate on their studies without worrying about paid work.  The increase in student numbers began slowly before the Second World War, but received a major boost in the post-war years.  1900 = 20,000 students  1938 = 38,000 students  1962 = 113,000 students  Oxford and Cambridge had dominated university education before the 20th century and continued to play an important role after 1900: they still educated 22% of all students in 1939 and grew to 23,000 by 1963.  Unlike Oxbridge, it was largely non-residential and allowed external students to sit final examinations.  London increasingly specialised in science, engineering and medicine. A number of smaller university colleges that had been founded under the guidance of older universities became fully independent, mostly after the Second World War. These included Reading (1926), and Nottingham, Southampton and Exeter (1948-57).  While this expansion represented progress, the proportion of 18-21 year olds in university education only increased from 0.8% to 4% between 1900 and 1962; in the USA, by contrast, 50% of that age group went to university. The figures are far smaller than one considers the working class or women separately: in 1961, only 13% of Oxbridge students were female and the number of working-class students there was tiny. The impact of the 1960 Robbins Report  The large numbers of returning troops, together with a sense of optimism brought by peace in 1945, produced a large post-war ‘baby-boom’ generation.  By the early 1960s, this large cohort was approaching the end of secondary education.  The government asked Lord Robbins to lead a Commission on Higher Education to investigate the situation and make recommendations. Robbins identified the key areas for concern as funding and the number of places available for prospective students.  His 1963 report recommended that a universal national grant be provided to all students with a university place, and that there should be a large increase in state funding to enable the growth of university places. The advice was acted upon, with some impressive results.  Between 1962 and 1970, the number of universities increased from 22 to 46. Many of these, such as York and Lancaster were known as ‘plate-glass universities’ because of their unique architectural style.  In 1964, the Labour government further increased access to degree-level education through the creation of the Council for National Academic Awards (CNAA). This enabled non-university institutions to award degrees: 34 technology colleges elevated their status to polytechnics, which were meant to have the same status as universities. As the polytechnics continued to focus on vocational skills and offered degrees there were seen as inferior, their status was never truly as high other universities. The CNAA also enabled the launch of the Open University in 1969 (in conjunction with Harold Wilson’s Labour government). This was aimed primarily at adults and made use of radio and television to facilitate remote learning by correspondence.  The Robbins Report led to an impressive boom in university education: 15  Between 1970 and 1983, the number of full-time students increased from 185,000 (31 percent female) to 237,000 (42 percent female).  Despite this, the number of students in higher education remained far lower than in other advanced industrial nations.  The social impact of increased university education was also significant:  With a more highly educated workforce, the number of people who could demand high salaries for skilled jobs increased.  A recurring theme of governments after 1945 was equality of opportunity and universities helped to ensure this was possible.  A university degree was no longer the preserve of the rich and was, instead, for working-class people to ultimate sign of increased social mobility.  Expectations of young people also began to change: the pressure to leave school (and home) at a young age was not as strong as it had been before the war. Chapter Summary  The 1918 Education Act saw education funded by  The 1950s, 1960s and 1970s saw the growth of central government but organised by local comprehensive schools to promote equality of education authorities (LEAs). educational opportunity more effectively.  Provision varied according to LEA but most ran  The Education Act 1976 shied away from the grammar schools funded by fees or scholarships complete abolition of selection but cut funding for bright pupils. to direct grant grammar schools which had  The onset of the Second World War and the taken many bright working-class children. Beveridge Report of 1942 highlighted  Progressive education based on child-centred shortcomings in educational attainment in Britain. learning developed both in mainstream schools  The 1944 Education Act introduced a tripartite and outside the formal system. system of grammar, secondary modern and  Concerns with the overall quality of education technical schools, based on selection, often led to the Black Papers and the 1976 Ruskin through the eleven-plus examination. speech, initiating a ‘great debate’ which saw the  Grammar schools were often excellent but advocacy of schools becoming more secondary moderns, taking up to 75% of the yearly accountable to government and parents. intake, were often poorly resourced and staffed,  More middle-class and working-class students and comparatively few technical schools were ever went to university during the interwar years. built.  The Percy and Barlow Reports highlighted the  The 1959 Crowther and 1963 Newsom Reports need for more science and technology-based highlighted the unfairness of the current system university education. The Robbins Report of and low attainment of less affluent pupils. 1963 led to the rapid expansion of university education in the 1960s and 1970s. 16  Key Question Topics How successfully The extent and nature of welfare provision, 1918-39 did British governments The impact of the Second World War, the Labour Government provide welfare and consensus, 1939-64 support in the years 1918-79? Reasons for increasing challenges to welfare state provision, 1964-79 Why, and with Health provision, 1918-45 what impact, was the National The creation and impact of the NHS, 1945-79 Health Service created in 1948? The challenge of medical advances, 1945-79 Education policy, 1918-43 To what extent has educational The impact of the Butler Education Act and the Crosland reform led to Circular, 1944-79 widening opportunities? The growth and social impact of university education, 1918-79 17