The Forgotten 'Cradle to Grave' welfare state: a comparison of local and national health care

The transfer of health care from a local to a national responsibility in the UK may be seen in the terminology of historical institutionalism/ 'path dependency' as a 'path change' or in the terminology of policy learning as a paradigm change. This is because of the movement from local to national citizenship, and from a local to a national welfare state. The inter-war period is often regarded as the high point of local government in the UK, with the Ministry of Health advocating a policy of locating services in the larger local government units of the urban county boroughs and the more rural county councils. Predating the term's association with the Beveridge welfare state after the Second World War, a British MP, Mr Marshall, claimed that local government provided services 'from the cradle to the grave'. The evolving plans for the National Health Service were all based on local government, and Aneurin Bevan's nationalisation of the hospitals was regarded as a bold step that was seen only a few years earlier as not practical politics. In this paper, we compare 'ideal types' of local and national welfare states, drawing on a study of municipal medicine in the inter-war period to examine this change in terms of changing discourse, institutions, policies and politics. As most social policy writing tends to fall within the assumptions of the national welfare state, we highlight the assumptions, successes and failures of the local welfare state.