The UK coalition government's planned NHS and welfare reforms, and their use of 'nudge' theory, hark back to ideas on welfare and recession from the end of the nineteenth century, according to studies by a University of Leicester historian whose research paper has recently been published in the Lancet.
Dr Kim Price's article is entitled, 'The crusade against out-relief: a nudge from history.'
Dr Price, a Wellcome Trust Research Fellow in the School of Historical Studies, commented: "Broadly speaking, I am interested in medical negligence under state medicine and I have focused on the pre-NHS (pre-1948) welfare system in the UK.
"The instability of doctor-patient relations has led to a fragile balance of power that is by no means set for the foreseeable future.
"The welfare debate has been divided for centuries by ideologically-driven attitudes to philanthropically, privately or publicly funded medicine.
"I see medical negligence as a complex relationship between time and place and, to varying degrees, society, law, ethics, medical practice, health professionals, and patients."
In his paper in the Lancet, Dr Price argues that the UK's Coalition Government has begun to tackle the annual deficit with the language and policy aims from the recession of 1870.
In the late 19th century the Conservatives instigated a policy to cut back welfare expenditure and lessen reliance on poor law out-relief. This included cutting medical extras and payments to lone mothers, widows, the elderly, the chronically sick, and people who were disabled or had mental illness.
The result, Dr Price believes, lowered the health of many families and increased the number of people who could no longer be supported at home.
Dependency was criticised by both government and ratepayers, until by the 1880s the Victorian obsession with thrift and self-help had taken hold throughout the voting classes. Philanthropy and charity, however, could not compensate for government aid, and institutional care drove up national expenditure.
Dr Price argues that, under current UK Coalition government proposals for GP consortia, and its potential conflicts of interest, the doctor-patient relationship is in peril of shifting too far in favour of doctors and undermining the trust of patients.
This too harks back to 19th century Poor Law doctors who had to choose between their private and public patients, resulting in widespread neglect of the poor. As a result relations between doctors and poor patients suffered.
At the turn of the 19th and 20th centuries the drive to cut welfare backfired and fuelled change. Liberal (and later, Labour) reformers raged against the "false economy" of a nation without welfare so that by the start of the 20th century, the tide had begun to turn.
The people's health took centre stage when working class people as a whole were allowed to vote, resulting in a series of Acts which led towards the creation of the National Health Service in 1948.
- Kim Price. The crusade against out-relief: a nudge from history. The Lancet, Volume 377, Issue 9770, Pages 988 - 989, 19 March 2011 DOI: 10.1016/S0140-6736(11)60376-0
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