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Duty to care
In defence of universal health care

This paper is part of the Social State project.

England is not alone in its assault on universal health care. Across Europe countries are cutting health service budgets in order to deal with public and private debts created by the banking crisis. Proponents of the argument that tax-financed or ‘free’ health care is a privilege we can no longer afford are unable to explain why universal health care was instituted when the world’s economy was very much smaller than it is today. This paper asks - if the UK could create an NHS when the country was literally bankrupt, why in England (but not in Scotland or Wales) can the government not sustain the NHS today? They suggest the answer is political and not financial and that the response of the left must be political too.

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The Beveridge Report of 1942 noted the threat to society from the Giant Evil of ‘disease’ and announced the intention to provide a nationwide health service. In 1946 the aim was embodied in law and in 1948 the NHS came into being. The NHS has been an international model ever since because it provided what no other country in the world has achieved at the same cost: universal health care in the form of equal access to comprehensive care, irrespective of personal income.

This paper shows how the original welfare state model of the NHS enshrined government responsibility for universal health care in the duty on the Secretary of State to secure or provide comprehensive health services. The architects of the NHS recognised that equity in health care could only be achieved by sharing the risks and costs of care across the whole of society from rich to poor and from healthy to sick. It was for this reason they embedded solidarity and collective provision into the structures and mechanisms underpinning the system of funding and for delivery of care. Behind these arrangements was the Secretary of State’s core duty to provide or secure a comprehensive health service.

The paper goes on to describe how the duty was abolished under the Health and Social Care Act 2012 and looks at what this means for health care in England. They argue that while the duty to provide comprehensive health care to the whole population was in place, the government was limited in the extent to which it could open health services to the market and introduce user charges. They assert that abolition of the duty makes it easier to transform the English NHS from a nationally-mandated public service into a number of fragmented and competing services based on commercial contracting and providers with limited accountability.

Finally, the paper argues that reinstatement of the duty and the system it encapsulates must be the cornerstone of health policy in a Social State.