Introduction

This chapter examines the evolution of consumerism in UK health and social welfare policy with particular respect to older people. The chapter outlines the chronology of changes in health and social policy that have particular resonance for older people and the significance of these changes within ‘a society of consumers’ (Bauman, 2007, p 52). We chart the development and expansion of the post-war welfare state from its origins in the late 1940s to the mid-1970s, the ‘crisis’ of the welfare state and the subsequent reformulation of welfare policy that took place during the 1980s and 1990s. We go on to outline the new conditions of welfare consumerism that have been pursued by new Labour within a ‘choice and voice’ agenda before addressing our final theme, the potential significance of devolution for the diversification of welfare policy in the new Britain of the 21st century. The chapter ends by considering the role of health and social policy in the reconstruction of the older citizen.

The development of health and social care for older people in the post-war period

Prior to the creation of the National Health Service (NHS) in July 1948, healthcare in Britain was provided by a mixed system of hospital and primary care provision that was generally regarded as inadequate and unfair. Hospital care varied by geographic area, depending in part on the strength of local voluntarism and on historical circumstance, and was unequal in terms of quality and quantity (Mohan, 2003). Access to acute hospital treatment and to what we now term primary care was mostly contingent on the ability to pay. Two parallel hospital systems existed: the voluntary sector, self-governing and independent, and public hospitals that were, in theory at least, under the control of the local authorities. Substantial proportions of the population were unable to afford care of any sort, while others had access to only rudimentary forms of healthcare. Among the most disenfranchised were older people and those with chronic conditions, physical and mental.