The Coronavirus pandemic has laid bare the realities of a struggling care sector unable to cope with the demands of an ever-aging society. Despite Health Minister Sajid Javid’s full job title being the Secretary of State for Health and Social Services, a chronic imbalance between his two briefs has grown and has highlighted that action needs to be taken. Using the lessons of Disraeli’s ground-breaking public health reform in the 1870s, this article makes the case that the time is now for a National Care Service.
Development in British public health policy has a gradual beginning, with its roots in the 1848 Public Health Act. Spearheaded by the work of Edwin Chadwick and following the particularly severe outbreak of cholera in the same year, the act created a Central Board for Health, and became the first law within Britain regarding public health.
Public health policy really began to evolve in the early 1870s when Prime Minister Disraeli’s reformative government sought to further address the issue of poor public sanitation. Both the Public Health and Artisans’ Dwellings acts were passed in 1875, beginning the first concerted push to improve public health. Provisions were made to build housing with running water and to enable local authorities to begin replacing slums with better quality housing. Progress was slow, but was nevertheless a radical first step forward in the context of Victorian Britain, which was lauded by early trade unionists who recognised the government’s actions as extensively improving the public health of the masses.
What brought about such radical reform? The source of Disraeli’s public health reform can be found from two places. The first, necessity. The second, external pressure. The first is perhaps self-explanatory. Poor sanitation amongst the working classes helped no one. In fact, as Edwin Chadwick had noted in his commission on working class sanitary conditions back in 1842, families of working men who got sick were more likely to need the government’s poor relief.
However, it was the large human cost of repeated outbreaks of disease that ultimately forced the government to act. The 1860s saw a significant push for greater rights for the working classes. In 1866, as Parliament discussed expanding the voting franchise, 200,000 protested in Hyde Park. Furthermore, Marx’s Das Kapital had its first volume published in 1867, and philosophers-turn-parliamentarians such as John Stuart Mill were influentially bringing their ideas into the public foreground. The government, undoubtedly casting their mind back to continental Europe 1848, conceded that public health had to become a political priority.
How, however, can we apply such lessons from Disraeli’s reformative public health policies to a contemporary, 21st century setting? If sanitation was the central public health issue plaguing Disraeli’s government, what then is Johnson’s public health dilemma (putting aside momentarily the overtly obvious answer of the pandemic)?
The answer is social care. The century-and-a-half following Disraeli has seen significant progress in the forum of public health. Sanitation and hygiene have been expanded to the point where all have access to clean water, a working sewer system, and are free of poor-hygiene related outbreaks of disease. And of course, the jewel in the British state, the National Health Service, founded through the necessity of rebuilding after the War, and the external pressure economic advisors such as Beveridge placed on the government, has provided access to free healthcare for everyone.
Social care, however, has been largely untouched. As a private industry, it has often remained out of reach of the less privileged within our society, much as basic sanitation remained out of reach for the working classes of Disraeli’s day. Consequently, as our country’s population continues to age and a greater proportion of us reach the stage where we require assistance to carry out some of our basic functions, many are being priced out of having a meaningful last few years of their lives.
In other words, as our country ages, we will reach a point where it is unsustainable not to approach the issue of social care. As was the case in 1875, reform is necessary. A lack of social care services only serves to provide greater pressure on the NHS, which often cannot discharge patients due to limited support.
This reform should take place in the form of the creation of a National Care Service. A radical assumption of responsibility by government, as with Disraeli’s public health policies, will better organise social care. The pitiful distribution of PPE during the pandemic within care homes shows that a market model is not just pricing many out of social care, but also failing to properly supply those who can afford it.
When Jeremy Hunt proposed a National Care Service as part of his campaign to become Conservative Party leader in 2019, that urgent need to reform was there, yes, but the external pressure that Disraeli’s government had was not. Whilst Corbyn’s Labour Party included plans for a National Care Service within both their 2017 and 2019 manifestos, these pledges were often overshadowed, both by other manifesto pledges which gained greater media attention, such as free tuition, and the ubiquitous topic of Brexit.
Covid’s refocusing of the political lens from issues surrounding exiting the European Union to those surrounding public health has finally provided the opportunity to pressure the government into action. As the NHS was built from the recovery of the War, so too must the National Care Service be built from the recovery from the pandemic.
Overall, Disraeli’s example is one that must be followed. Social care reform must start. The creation of a National Care Service will serve to help address the issues of our increasingly aging and unequal population, just as Disraeli’s reforms did 150 years ago.
Matthew Lambert, History in Politics Summer Writer