Why we need a new ‘Beveridge moment’ for social care in the 21st century

2023 is not only the 75th anniversary of the National Assistance Act, it is also the 45th anniversary of the beginning of my career. In June 1978 I began working as a social worker for Wakefield Council. I have held roles as a director of social services, as a senior civil servant advising on social care reform, as a regulator of the quality and safety of health and care services and more recently as a non-executive working in health education and as a member of the NHS England board.

In all those roles I have often asked myself ‘How did we get here?’

David's blog is part of a series of blogs reflecting on the 75th anniversary of the National Assistance Act. To read more of these, please visit our project page.

As a student I studied the evolution of the welfare state in Great Britain – the role of philanthropy, the voluntary and charitable sector responding to the rapid changes that were taking place in the rapidly developing industrial society of the 1800s. Many of the great social campaigners lobbied for the governments of the day to act to relieve poverty and destitution, provide education, regulate work, provide safe water and thus improve public health, and provide health care and ‘asylum’. I continue to admire the courage of people like Beatrice and Sidney Webb, Thomas Barnardo, William Booth and Joseph Rowntree. Governments did act and legislated to address the challenges faced by society. Many of the changes introduced during the 1800s have continued to influence the welfare state throughout my working life, such as the principle of less eligibility that underpinned the Poor Laws and the role of local authorities protecting public health to name but two.

'Many of the changes introduced during the 1800s have continued to influence the welfare state throughout my working life.'

Margaret Mead, an American anthropologist, once said ‘Never doubt that a small group of thoughtful committed individuals can change the world. In fact, it is the only thing that ever has.’

My career has been shaped by the architects of the modern welfare state: the roles of Aneurin Bevan, Ernest Bevin and Clement Attlee in the post-war Labour government are well documented and understood. However one other person stands out for me and that is Sir William Beveridge, a civil servant who was asked in 1941 to chair a committee on social insurance. His report, Social insurance and allied services, published in 1942, provided the foundation for many of the reforms that followed in health, national assistance and education.

There were three guiding principles to Beveridge’s recommendations. First, any proposals should not be restricted by sectional interests – they should be bold. Second, social insurance should provide income security and attack “want” (addressing the political challenge between the two world wars of the impact of unemployment ). Famously he saw the five giants to be tackled as want, idleness, disease, ignorance and squalor. And third, social security was to be achieved by co-operation between the state and the individual. Beveridge, like his predecessors the philanthropists, set out a ‘social contract’. It was a social contract that responded to the needs of people in the middle of the 20th century. The response was overwhelmingly favourable and has undoubtedly transformed the lives of every generation since its founding.

'Trust in our institutions and politics is eroded. Society is becoming more divided and polarized.'

However as we enter the middle of the 21st century with the challenges of demography, an ageing population, science and technology developments and climate change, many in society feel that the social contract is not working for them. Trust in our institutions and politics is eroded. Society is becoming more divided and polarized.

In her excellent book, What we owe each other, Minouche Shafik makes the argument that a new social contract is required, one where we ‘rebuild the mutual trust and support on which citizenship and society is based.’ She defines a social contract as ‘the basic set of rules, norms and mutual obligations that bind together individuals, firms , civil society and the state.’

'We now need a new ‘Beveridge moment’, a new social contract for social care, to take us into the middle of the 21st century.'

We now need a new ‘Beveridge moment’, a new social contract for social care, to take us into the middle of the 21st century.

The challenges in the UK of an ageing society are real and significant and the current system has been at a ‘tipping point’ for years. We are living longer but we live more of those years in poor health. Allied societal changes include the developing role of women in society , the changing nature of family structures which are also  becoming more dispersed as people move to secure employment . Society wasn’t facing these challenges in the 1940s when the welfare state was being developed by Beveridge, Bevan, Bevin, Attlee and many others. They listened to the lived experience of their citizens shaped a vision of a better society, a society that they wanted people to benefit from and contribute to, and we must now do the same.

As we celebrate the 75th anniversary of the National Assistance Act we must use this time as a springboard to create a Beveridge momentand develop a new social contract for care that responds to the needs of society in the 21st century. After so many mis-steps in the reform of social care of the past 25 years, let’s make the case for why the next government in the UK should use the lessons of history to reform social care and create a new social contract to meet the needs of its 21st century citizens.