United Kingdom

Although the NHS is a popular institution, it is not without problems: resources are scarce, many hospital buildings are old, there are waiting lists for nonurgent conditions, the distribution of health care by social class and by region is less equal than many would wish, and management needs to be improved. The advantages, however, are enormous. The NHS is very inexpensive by international standards; in the late 1990s, for example, the United Kingdom spent about half the percentage of GDP on health care as the United States. Despite such low spending, health in the United Kingdom, measured in terms of infant mortality and life expectancy, matches that in comparable countries. The variation in the quality and quantity of treatment by income level is smaller than in most other countries. The system is able to direct resources toward specific regions and specific types of care. Treatment is free, whatever the extent and duration of illness, no one is denied care because of low income, and no one fears financial ruin as a result of treatment.

Cash benefits

The current system of cash benefits, though substantially modified since its introduction in 1946, is based on the 1942 “Beveridge Report.” Every employed person pays a national insurance contribution, which since 1975 has taken the form of a percentage of earnings, although contributions are due only on amounts up to about 150 percent of nationwide average earnings. Employers collect the contribution, and there is also an employer contribution. Separate arrangements exist for the self-employed. The revenue from contributions goes into the National Insurance Fund.

Insured individuals are entitled to unemployment compensation, cash benefits during sickness or disability, and a retirement pension. There are also benefits for individuals injured in work-related accidents and for widows. Whether or not they receive an insurance benefit, all are eligible for a noncontributory benefit. Employees who lose their jobs through no fault of their own receive lump-sum redundancy, or severance, payments, whose cost is met in part by their employers and in part from a general levy on employers.

The major noncontributory benefits, paid out of general tax revenues, offer poverty relief to individuals and families whose income and savings fall below some prescribed level. The benefit of last resort is income support (formerly called the supplementary benefit); it is payable to individuals whose entitlement to insurance benefits has been exhausted or has left them with a very low income and to those who never had any entitlement to an insurance benefit. Other means-tested benefits assist low-paid working families with children and help people on low incomes with their housing costs. An important class of noncontributory benefits is not means-tested, the major example being the child benefit, a weekly tax-free payment for each child, usually payable to the mother.

The 1946 system has changed substantially over the years, with a burst of reform in the mid-1970s, including an increase in earnings-related pensions, and another in the late 1990s. In the late 1990s a working-families tax credit replaced income support for low-paid working households with children, and the government introduced a national minimum wage. The government also introduced a children’s tax credit to provide additional support to low- and middle-income families. There was a review of the benefit system in 1985 that changed the detailed workings of several benefits in 1988 but left the basic structure intact.

Housing

During the mid-20th century, local governments developed council houses (public housing estates) throughout the United Kingdom. At public housing’s peak, about 1970, local governments owned 30 percent of all housing in the country. Under the Housing (Homeless Persons) Act of 1977 (which amended older legislation), local governments have a statutory obligation in certain circumstances to find housing for homeless families. Partly for that reason, they keep a substantial stock of housing for rent, maintain waiting lists, and allocate housing according to need. Following the introduction of “right to buy” legislation in 1980, many tenants became owner-occupiers. By the beginning of the 21st century, the proportion of homes owned by local governments had almost halved.

Education

Primary and secondary education

Overall responsibility for education and children’s services in England rests with the Department of Education, which is accountable to Parliament. Separate departments of education are headed by ministers who answer to the assemblies in Scotland (Education and Lifelong Learning Department), Wales (Department of Education and Skills), and Northern Ireland (Department for Education). State-funded primary and secondary education are a local responsibility, generally overseen by the local authority. There is also a small private sector.