ANTI-DISCRIMINATORY HEALTH CARE PRACTICE

Anti-Discriminatory Health Care Practice



Anti-Discriminatory Health Care Practice

Introduction

In the UK, Health and Social Care is a broad term that relates to integrated services that are available from health and social care providers. It can also mean a range of vocational and academic courses which can be taken at various academic and vocational levels from GNVQ, A-Level, S/NVQ, to degrees.

As a subject discipline, Health and Social Care (H&SC) combines elements of sociology, biology, nutrition, law, and ethics. Typically, students of Health and Social Care will have a work placement alongside their academic studies; such a placement may take place in a nursery, residential home, hospital, or other caring establishment. Others may take a health and social care course as a route to further qualifications hoping that it will lead to employment within the sector.

National solidarity, nondiscrimination and the welfare state

Some commentators attach a lot of importance to the process of defining citizens and noncitizens for social policy purposes. Ferrera (2005: 4) has argued that the territorial basis of social protection captures the 'elementary yet fundamental mechanism through which social solidarity is typically generated: a mechanism which we can term “internal bonding through external bounding”.' Leibfried (2005: 263) claims that '“citizen-making” through social benefits - demarcating the “outsider” - was a watershed in the history of state-building on the continent'.

A central difficulty with these claims is that they imply that the common bond of nationality is the basis for the political acceptability of redistributive policies. This conflicts with most accounts of welfare state policy-making, which instead alert UK to the importance of assembling constituencies to support social policies, whether the emphasis is on the necessity of capturing the middle classes (Baldwin 1990) or on the development of solidarity among the working class and its political and industrial mobilisation (Esping- Andersen and Korpi 1984). Theories of the welfare state also highlight the diverse ideational rationales for social provisions: how ideas about contribution, deservingness and need are combined in multiple layers of provision (e.g. through the parallel operation of insurance and assistance) or even combined within the eligibility and entitlement provisions of a single benefit (Bolderson and Mabbett 1995, Hacker 2004).

Studies of policy-making in the welfare state also show that national legislation demarcating outsiders has not shown the clarity of purpose that the 'national solidarity' view would suggest. Exclusion of migrants is, if anything, a recent tendency rather than a foundational principle (Sainsbury 2006). The question of who to exclude is far from straightforward: countries have numerous different immigration statuses, covering everyone from visitors, students and temporary workers to permanently resident non-nationals. Social legislation does not demonstrate that policy-makers have taken a coherent and systematic approach to defining the consequences of these distinctions for social entitlements.

A great deal more social policy-making effort has gone into defining the 'internal' boundaries of eligibility for particular benefits than has been devoted to the 'external' boundaries of defining and distinguishing citizens and migrants. Internal boundaries are constituted by, for example, provisions restricting benefits to ...