Health and Welfare since 1950, State Provisions for

Ireland evolved from an economically backward, insular, and largely agricultural country to one of the richest nations in the world by the close of the twentieth century. Over the final quarter of the century the welfare state, which began to develop after the World War II, slowly matured from a residual system catering largely for the poor and the working class to a comprehensive one. Elsewhere in Europe, politically strong labor movements gave momentum to the development of welfare states during postwar reconstruction. However, the Ireland of 1950 was still predominantly a rural society, with the urban working class making up less than a quarter of the workforce. The Catholic Church's social teaching, which favored a minimal welfare state, was heavily influential in the formation of policy. Initial government plans in the late 1940s proposed comprehensive social insurance and an outline national health service, both closely modeled on the recommendations of the United Kingdom's Beveridge Report (1942). However, far more timid proposals were actually implemented, in contrast to the Beveridge-style welfare state developed in Northern Ireland.

The setting up of new Departments of Health and of Social Welfare in 1947 marked a shift from local to central government as the driving force in social provision. (Social welfare is the term customarily used to describe both social security [social-insurance] and parallel means-tested welfare payments.) The Department of Health's ambitious hospital-building program of the 1940s and 1950s put in place a modern hospital infrastructure. The new social-insurance system (1953) rationalized previously fragmented social-security provisions into a single national scheme, but the middle class, the public service, and farmers remained outside its scope. Social-insurance pensions were not introduced until 1961. The social-insurance system closely followed the U.K. model, with flat-rate payments rather than the earnings-related benefits of continental Europe.

The Catholic Church backed the medical profession in strongly opposing a proposal for free medical care for mothers and children, in a clash that led to the fall of the government in 1951. This victory by church and medical interests helped to fix a model of mixed public and private medical care that continues in the early twenty-first century. However, in spite of initial church misgivings that such a scheme would "lower the sense of personal responsibility and seriously weaken the moral fiber of the people" (Barrington, 1987: 235), free hospital care for the low- and middle-income groups was introduced from 1956. Public-sector medical consultants retained a right to private practice. The state-run Voluntary Health Insurance Board set up in 1957 helped to underpin private hospital care. In 1991 the entire population was made eligible for free hospital care as public patients. Encouraged by speedier access to treatment for private patients, however, almost half the population were insured for private hospital care in 2000. A segregated system of free family-doctor care for the poor through dispensary doctors was abolished in 1972. Public patients now have a choice of family doctor and are treated in general practice alongside private patients.

As the more prosperous Ireland of the 1960s modernized, urbanized, and opened up to the outside world, the philosophy of a minimalist welfare state was replaced by a new emphasis on developing and expanding social services. Catholic Church influence began to wane, ironically as the post-Vatican II church now favored an active approach of expanding welfare provision and tackling poverty.

The 1970s was a decade of expansion for social welfare. Among the new payments introduced were retirement pensions at sixty-five, invalidity pensions, and death grants. The old-age-pension age was reduced from seventy to sixty-six. A uniform safety net called supplementary welfare replaced discretionary assistance dating back to the poor law. Social-insurance cover was extended to the middle class. The changing family was reflected in new schemes of unmarried mother's allowance, deserted wife's benefit, and deserted wife's allowance, modeled on payments to widows. In the 1990s these became the gender-neutral "one-parent family payment."

Since joining the European Union (EU) in 1973, Ireland has become more exposed to social-policy influences from outside the U.K. European Union laws, in particular those prescribing equal treatment for men and women, and EU-funded social programs have been important in shaping policy. Up to the 1980s Irish women's workforce participation was very low. Indeed, before 1973, women public servants lost their jobs on marriage. Ireland's social-welfare system, as in the United Kingdom, was designed around a male breadwinner. Payments to men included additions for a dependent wife and children. Up to 1986 married women's benefits were severely curtailed until the European Directive (79/7/EEC) on Equal Treatment for Men and Women in Social Security ended formal discrimination against women in the welfare code.

As women's workforce participation increased dramatically during the economic boom of the 1990s, a vigorous debate raged about state assistance toward childcare costs. Although tax relief for childcare costs was the favored option of the trade unions, the government was wary of ignoring low-income parents and of alienating full-time parents. So the chosen form of childcare subsidy, implemented from 2001, was to grant substantial increases in the social-welfare child benefits paid to all families.

Across the Western world the recession of the 1980s and changes in the dominant ideology led to moves to contain costs and to curb the welfare state. In Ireland the recession of the 1980s was particularly deep and was exacerbated by a crisis in the public finances. Health spending was restricted, and the number of hospital beds was reduced. The policy shift toward community-based care and away from large institutions brought even sharper reductions in the number of psychiatric beds.

In spite of cutbacks elsewhere, during the 1980s social-welfare benefits improved in real terms alongside a steep growth in spending as unemployment soared. The Commission on Social Welfare (1986), which conducted the first systematic review since the late 1940s, argued for benefit levels that would be adequate relative to incomes elsewhere in society. It also recommended simplified and rationalized payments to the different categories of recipients, along with comprehensive social insurance. Subsequently, social-insurance cover was extended to the self-employed, to part-time workers, and to newly recruited public servants.

The lowest rates of welfare payments were increased significantly, bringing them closer to incomes from work. To encourage movement from welfare to work, rather than cutting or limiting existing benefits, complex new benefits for the reemployed were introduced. Continued improvement in welfare provision in Ireland took place at the same time as the welfare restrictions of the Thatcher years in the United Kingdom. This brought Irish social welfare payments ahead of those in Northern Ireland for the first time.

Traditionally, services for people with disabilities depended heavily on state-aided voluntary-sector initiatives. From the 1980s however, EU training funds helped to expand day places for people with disabilities, such as in sheltered workshops. The 1990s saw the first systematic assessment of needs in relation to people with mental handicaps, along with significant funding to expand services.

The difficult economic conditions of the 1980s gave birth to a new form of social partnership. From 1987 on, a series of detailed economic and social programs were negotiated between government and the social partners, initially embracing employers, trade unions, and farmers. From 1996 on, social partnership expanded to include organizations of the unemployed and other community interests. A trade-off between modest pay rises and tax cuts has been at the heart of these national agreements. This has tilted the balance more toward tax reductions than improved public services. Social-service spending has grown but has not matched the exceptional rise in GNP experienced in the 1990s. But specific improvements in services (for example, free hospital care for all) were negotiated as part of these agreements. Influential working groups on specific topics set up under the social partnership have helped to shape the details of social policy.

From small and slow beginnings after 1945, Ireland had developed a modern welfare state by the close of the twentieth century. Flat-rate social-insurance benefits and a substantial private health-care sector have yielded an Irish welfare model closer to U.S. and U.K. systems than to those of northern Europe.

SEE ALSO Equal Economic Rights for Women in Independent Ireland; European Union; Farming Families; Mother and Child Crisis; Social Change since 1922; Primary Documents: Letter to John A. Costello, the Taoiseach (5 April 1951)

Bibliography

Barrington, Ruth. Health Welfare and Politics. 1987.

Burke, Helen. "Foundation Stones of Irish Social Policy: 1831–1951." In Irish Social Policy in Context, edited by Gabriel Kiely, Anne O'Donnell, Patricia Kennedy, and Suzanne Quin. 1999.

Conroy, Pauline. "From the Fifties to the Nineties: Social Policy Comes Out of the Shadows." In Irish Social Policy in Context, edited by Gabriel Kiely, Anne O'Donnell, Patricia Kennedy, and Suzanne Quin. 1999.

Cousins, Mel. The Irish Social Welfare System, Law, and Social Policy. 1995.

O'Connell, Philip, and David Rottman. "The Irish Welfare State in Comparative Perspective." In The Development of Industrial Society in Ireland, edited by John H. Goldthorpe and Christopher T. Whelan. 1992.

Eithne Fitzgerald