Social policy Themes and approaches Paul SpickerContents Preface: The study of social policy xi ‘Typeset in 102pe Palatino ‘Acknowledgements ~ oF Photos, Lagan Devon Printed ae bound in Great asin by nternationa ad PARET UHDeRStANDGHG SOCAL POUCY : Introduction to Part 1 2 {rary of Congres Ctaloging in Publication Data 1. The nature of social policy 3 Spike, Pah ‘The nature of social policy 3 1 and approaches! Pal Spi. What is social policy? 3 What does icy study? 4 Why does social policy matter? 6 Social policy and the academic disciplines 8 ‘The methods and approaches of social policy 9 ‘Theory and practice 9 ‘The process of classification 2 ne Normative approaches 3 moseing Jn Fobteten Ds Comparative approaches 4 1 for his book avaiable rom Empirical research 18 7 Studying social policy 16 a 2. Welfare in society 8 wos76sas Of os 02 Gt 8 3s, groups and communities 20 20 21 2Introduction to Part 2 policy, through its implementation, to the receiving end. Part 2 concludes, like Part 1, with an attempt to bring .d of material together by considering how services are organised and delivered in different welfare systems, 7 | The policy process Power and policy ‘The structure of power Formal processes: law and the state Influencing policy Policy formation Implementation Power and policy ‘The collective provision of welfare is a political activity; it has to be seen in 1n refer to a very broad range of activity, and fhich there is some form of collective social action, of in which power is exercised, is ‘politica’ Power is defined by Russell as the ‘production jes that a number of effects might not be analysis of the concept tends to attribute tal a person has to affect the behaviour of is that the potential to affect others and the exercise of power are not genuinely equivalent, relationship there are at least two parties, and both parties affect each other. Thibaut and Kelley, considering the idea of power from psychological perspective, point out that a person who is being dominated is changing the pattern of behaviour of the person who is dominating. them. A child exerts a very considerable effect, whether intended or hin any power 98% SOCIAL POLICY: THEMES AND APPROACHES otherwise, over its parents, but to describe the child as ‘powerful’ is to do ‘moral, and whether it relies on reward or punishment ~ can be seen as an exercise of power. Lukes describes this kind of exercise of power im @ three-dimensional problem.* The secor defined by Bachrach and Baratz a only the first dimension dimension is a process has been suggested tha sae poor people, who are also those least likely to receive adequate service.” But, though the facts have been knoi Se 1g people into ‘and gender ribing this kind of control is that there is 2 people more than people of working age, because old people but that does not necessarily mean tht old people have mere Power than younger ones. I powers being exercised ite because theres fomething about the process through which values are constructed and maintained Which reflects the interests of the dominant group: snd that THE POLICY PROCESS ” ‘Although there are examples of the enforcement of norms, the problem in attributing them to the influence or control of a dominant group is that they often appear to reflect more than the interests of a narrowly defined ‘group. Intervening in cases of child abuse is a form of control, but the ‘moral norm protects the interests of children. Taking mentally ill people become unemployed through ‘misconduct’, the requirement to be ‘actively seeking work’ while unemployed, and the denial of benefits to people locked out by employers during industrial disputes. These actions can stil al imperatives which lead to bbe seen as forms of moral intervention; normative importance of social policy, if people did not allow mora judgments to obtrude in decision making. The emphasis on social control al purpose in drawing attention to the ways in which welfare tool for other ends, and ways in which it s recipients. policy can be used as ‘can act to the detriment The structure of power The interpretation of the exercise of power in social policy depends people who interests, and if people consistently have decisions made in their favour this may be evidence of power.%8 SOCIAL POLICY: THEMES AND APPROACHES Elitism ‘The argument that power is concentrated in the hands of a few people is best glescribed as an élitist view of power. Elitist theories might inchude a ruling élite, a small number of people able to make decisions; but they can also be based on a restricted number particular contexts."* ide: employers can also have burdens pay and maternity pay in Britain, or in France the obligation to provide housing for workers). A stronger ci ‘be made for the influence of financial institutions, like banks and insur compani financial institutions ~ including the arrangement pensions and conformity of public expenditure to the requirements sector, counterbalancing regulation by insurance available to bad risks, or to loan money on patti ‘weak. The great difficulty in amples of élite domination is that actions which prove to be in the interests of select groups are not necessarily brought about through the actions of those groups. In lottery, the person whois likely to win most is the person who has the most tick action to change the inequalities. ‘power’ by orfor afew people. To demonstrate élite domination, there has to be some evidence of a process through which élite control is exercised, and there is very little evidence of this type Pluralism Pluralist models see power as diffused, in the hands of many; no one group has the power consistently to sway decisions (although this docs not ‘mean that power is equally distributed in society). The belief that power is centred in many different places, with the effect that no single faction or bloc of factions is able to exercise power consistently in order to suppress others. Pluralism is often misrepresented by non-pluralists to mean the belief that power is equally and fairly distributed in society,” which no ” system of this sort would be more legitimal thing."* Pluralism can, however, re ywever, the only active pa tral government, local government, social housing. 01 sndowners, existing home owners, and those pt lude the environmental lobby, the housing lobby, an local economy (like local employers). The pluralist debates about such a policy as to be considered case by case. This is a diffcu fe, because any apparently contradictory information can be dismissed by an appeal for further study. involved with, Corporatism monopoly within their respet ‘observing certain controls on their selection of demands and supports = ‘There is no single agreed model of corporatism; the main definitions of ccorporatism seem to me to be expressed in three related senses, Socially, a100 SOCIAL POLICY: THEMES AND APPROACHES corporate structure is a hierarchical structure of power, characterised by restricted competition between a limited number of corporate groups, This is roughly what Schmitter’s definition implies. Economically, coxporatism is a system of economic organisation in which production is dominated by corporate structures concerned with corporate development - as opposed to the model of ‘capitalism in which ownership is identified with control and the primary objective is profit maximisation.” Politically, corporatism can be seen as a system of interest group representation and state intervention in which the state bargains with other agencies, delegating functions and co-opting them into the structure of power.”* ‘The common elements between these different understandings of corporatism are a stress on the importance of corporate activity ~ that is, activities undertaken by organisations and institutions — rath individual or communal action; an agreement that corporatism is exchusive of other interests; and the view that accommodation between corporations is achieved through bargaining and negotiation. The kinds of points on which corporatist analyses differ are first, whether the state directs activity, or itself acts as a corporate player negotiating and thers second, whether the structure of cnporaions is Schmitter) or polycentric’ — in other words, more like ike pluralism. ‘The arguments for interpreting the organisation of welfare in these terms ave strong; they apply particularly to the operation of medical care,” but a case can also be made for the incorporation of insurance and pensions schemes in much of Europe.” The corporatist approach helps to focus attention on organised groups and coalitions of interests. At the same time, its very ambiguity means that it offers no direct guidance about the structures of power and the relationships between organisations; its explanatory power is therefore limited. Ultimately, much of the literature on the structure of power is impossible to judge. Bltist, pluralist and corporatist views are interpretations of a process; an assessment of the policy process requires consideration of the relative influence of a range of actors, and although some explanations may. be ficult to see how any of them could be is to identify certain common themes ‘which run across the different concepts and understandings of power. * In order to understand the importance of power relationships it is not enough to consider the effects of policy; it is necessary to look at process. ‘* None of the main schools of thought about power considers that the exercise of power is the exclusive prerogative of an elected THE POLICY PROCESS 101 government. The state is seen at times as the instrument of other forces, and at times as a force in its own right; but in a modern society it has no monopoly of power. This means that resolutions have to be negotiated between parties. ‘© The question ‘who benefits from welfare?’ cannot be taken for granted; if the process of negotiation is itself important, that process itself can affect outcomes. Policy-making is not a “black ‘box’ in which decisions are made at one end and the policy produces a clear effect at the other; power has to be mediated. Formal processes: law and the state Politics is the process through which decisions are arrived at. This can be understood as referring both to the mediation of power, and fof the institutions through which power is exercised. Institutional processes are very important for the provision of welfare, both because they set the context within which welfare is provided, and because welfare is often provided directly through them. Many social policies are generated and mediated through the state. The of ‘the state’ are not always easy to define, because the term is used ry loosely; depending on the context, it can be taken to mean several things. Berki defines the state as ‘an institutional structure whose primary and distinctive function is the maintenance of authority in a given territorial unit.® The me tation of this structure is that the state is concerned wit ical institutions of a society. A wider view of the state would describe it as the means through which governmental power is exercised (which could include, for example, schools or hospitals) or the full range of government activity (which might include sponsorship of the arts). The formal political society are conventionally classified in three making), judicial, and executive (concerned “separation of powers’, there is not always a clear distinction between ‘them; the UK government sits in the legislature (Parliament) and the head ff the judiciary (the Lord Chancellor) is a member of the government. ‘The making of law is central to these categories. Law is the primary means through which a modern state exercises power. Lay people often think of law in terms of ‘criminal’ law, which is mainly concerned with prohibition and punishment; it is through criminal law, for example, that people are sent to prisor parents can be punished for neglecting or maltreating children, or that people are protected against fraud and corruption. But this is only a small part of the role of law in society. Law is,we SOCIAL POUICY: THEMES AND APPROACHES ‘much more generally, a system of rules and procedures through which the actions of individuals and people collectively can be regulated and govemed. Hart argues that laws can be classified as primary or secondary rales, Primary rules are those which set the terms by which other laws can be determined. They include rules of recognition ~ systems for recognising formal authority, and the laws themselves; rules of change, which make alteration in the rules possible; and adjudication, which is necessary for application and enforcement of the rules. Other laws are secondary.” Law making is important in social policy in four ways. Constitutional la. Laws form the framework through which policies are exercised. The powers of institutions have to be defined by law; they have to be given the competence to act. One of the most important developments in welfare polices in recent years has been the establishment by the European Community of competence in various areas related to welfare, including health, education, gender issues and social security; the Commission is still in the process of attempting to identify a role in relation to elderly people, disabled people, racial minorities, and people who are poor. Rule making. Law is used to establish the rules by which a policy is pursued, Law has been described as a system of ‘norms, that is, expectations which are coupled with sanctions in order to produce particular effects.™' So, for example, a law which states that people must send their children to school is @ positive norm (eequiting people to do something); a law which states that people must not do , such as renting out houses which are unfit for human is a negative norm. But legal principles are not confined to ‘what people should and should not do. One of the implications of constitutional law is that different bodies require their roles to be defined, and there is an extensive use in many systems of ‘permissive’ law, which gives organisations the power to undertake actions at ative law. Law is used to define executive processes — that is, the means by which services are to be delivered. Social security systems have not, in many countries, developed spontaneously; the usual process has been that at certain points legislation has been used ‘as a means of establishing procedures by which the state could take ‘on a major proportion of the responsibility for social protection, ‘Similarly, and often by the same processes, laws are used to regulate the conduct of the administration. Enforcement. There is often a negative sanction attached to laws, so that people or organisations who disregard them are liable to suffer some kind of penalty. A penalty against an organisation necessarily a penalty against the people who work for it, a ‘THE POLICY PROCESS. 109 sometimes difficult to think of any penalty which can be effective against a governmental organisation determined to break the rules; ‘respect for the rule of law’ is often the main sanction available ‘There is a considerable overlap between the establishment of norms and the provision of a means of enforcement. There are, however, many examples of laws which are not enforced, or enforceable. Some laws are exhortatory, encouraging people to actin 1 particular way. A Japanese law for the welfare of elderly people, for ‘example, states: “The aged shall be loved and respected as those who have for many years contributed toward the development of society, and a wholesome and peaceful life shall be guaranteed to them.’ Other laws offer guidelines rather than firm norms. The European Community has developed a system of what is called ‘soft law’, consisting partly of recommendations and partly of generalised sement about principles, which national governments are free to terpret.”* Social policy is not only made through the process of legislation. It can be 0 far as laws are passed which set out the policy, but it ‘made that is also possible for arms of government. ‘common, because much of what happens in social policy takes mace ata level which legislators are inclined to think is beneath their notice. These processes are not very different in principle, however, because in a properly constituted government the executive has to be empowered by the legislative authority before decisions can be taken, Influencing policy 4h legislation is considered depends strongly on the lual legislatures; for example, there are rather more opportunit terruption of the legislative process in the US than there are in the UK, which means both that the process of negotiation and. compromise is necessarily rather more refined, and that legislation is more spear. But there are some generalisations which might be processes through which interests are mediated. The range the structure of power; pluralist interpretations of power tend to look more ‘widely at the possible routes of influence, while élitist interpretations concentrate on those they believe are significant. There are certainly many groups vying for influence: in most cases in social policy they seem to Include politicians, civil servants, practitioners and recipient groups. PPluralist interpretations often accord special influence to people who are104 SOCIAL POLICY: THEMES AND APPROACHES seeking to persuade others, notably the mass media and pressure groups. Key argues that in two-party political systems such groups play an essential part; the ability of politicians to garner their own information is limited, and pressure groups inform the parties so that they can at least adopt some kind of meaningful postion on issues which otherwise would extend beyond their scope. It is difficult to identify the influence of the mass media, partly because they are disparate, and partly because the influence of the ‘public opinion’ they ae often suppone is itself not very easily identified. press in creating ich inform journal- opinion or as a way of reinforcing the dominant ethos. There a of consistent bias in political reporting, but the media are rarely consistent in their presentation of most socal policy issues: they range from moralistic condemnation of claimants to ‘human interest’ stories that seek to raise political awareness about issues, ‘The role of pressure groups is more clearly identifiable, and conse- quently of more immediate application to the study of social policy. Pressure groups are categorised as ‘interest’ or ‘representational’, and 4 wr ‘cause’ groups. An interest group is one which, like those direclly involved in certain issues. concerned with campaigning disinterestedly — ‘roups which ake stance foro against abortion, Eckstein also tlenties a third category, ‘attitude’ groups, which have no particular cause ot interest, but represent a coalition of like-minded attitudes: religious groups, which have been profoundly influential in welfare policy, are probably the best example. Pressure groups follow a wide range of strategies to influence policy. Whiteley and Winyard, examining groups which lobby government on tinguish not only promotional from representational groups, but also groups which concentrate on lobbying from those which offer service t0 poor people; groups which strive for a degree of of acceptance from those which do not (some groups are confronta and groups which focus their lobbying on particular targets, like government or civil service, from those which adopt an open strategy and seek to influence public opinion.” Poverty is an unusual topic, however, because there are relatively few clearly defined interest groups operating in the field, and those which do (like the representatives of civil servants) have interests in only a limited THE POLICY PROCESS 105 part of the sphere of operation. Health care has a much stronger range of ‘both professional and consumer interests; and where there is little direct public or media interest in an issue, the default negotiation falls between government and established interests of this kind, Policy formation Policies are formulated as the outcome of a series of negotiations; but this is not enough to explain how the agenda is formed, or how it is proceeded ing outlines five stages in policy formation: Awareness of the problem, Salience (or prominence). Specification of Choice between altematives.** tives, 1 2 3. The definition of the problem. 4 5. ‘Awareness of the problem’ might suggest, at first sight, that problems somehow come bubbling to the surface. Social problems are not, as I have explained, straightforward; there are complex conventions at work in their identification. The problems have to be ‘recognised’ by someone, and that is presumably someone different from the person who is suffering from them (who probably has a pretty good idea that they have a problem). ‘Most recently, child sexual abuse has been ‘discovered’; there was plenty of evidence of it before, but many professionals (including Freud himself) refused to believe it. There is implicit in the idea of ‘discovery’ a statement about power in society: that those who have power and control ional agendas are those who have to recognise the problem — how far the problem stands out - is conditioned by several issues, Hall, Land, Parker and Webb emphasise the of legitimacy: it must be seen to be right, and people have to st some action ought to be taken. They also argue that policies 1pport’; someone has to want them." This reflects, necessarily, the structure of power. There are several other factors which play a part ~ notably immediacy. George Bernard Shaw once commented that scandal hhas had a much more immediate effect on policy than research ever has: the desire to do something now is far more likely to be generated by instar events (like catastrophes, sensational prosecutions, and ‘news’ incident ‘than by research which documents a process over a long period such as the problems of inequalities in health, the treatment of prisoners or105 SOCIAL POLICY: THEMES AND APPROACHES inadequate residential care for elderly people. By cont jons, and assaults on old people in i long after the problems which foste in the study of social policy. There is a lesson here for campaigning groups: they have not just to show that there is a problem, ‘but to find an incident on which to focus. The definition of the problem is conditioned by politcal ideology and circumstances, The problems of ‘single parents’ have been presented in the problems of irresponsible hospital deaths, tions can become em have become dependency include the problems of poverty, the participation of women in the labour ‘market, and the lack of supportive networks for children and people who care for them, The issue is interpreted very differently in France: one of the Sulficient people of working age inthe next century to support the rest of the population. The problem isn # women have babies without the support of fathers but that not enough people are having babies at all. This in turn conditions the specification and choice of alternatives. Hall et al. suggest a test of feasibility: a measure has to be practical.® This is important for effective implementation, but itis disputable whether necessary for a policy to be adopted: many developed legal systems are Much more important than ‘feasibility’ is the way that the proble ised’ ~ that is, translated into terms which can be responded to. sexual abuse of children is complex, and it can be dealt direct responses include the punish direct responses, which address perceived causes, include (for the monitoring of parenting, education in parenting, education about male sexuality (because most abuse is by males), and the control of pornography. One of the problems in responding effectively to events ‘which provoke moral outrage is that the answers are often seen as being self-evident; they rarely are Implementation ‘The political process does not finish with the formation of policy; policies still have to be put into practice, or implemented. Implementation is not a simple procedure, in which policies produce a clear, unambiguous response; practice can equally be a forum for conflict, negotiation and the THE POLICY PROCESS 107 exercise of power. Lane outlines eleven different models of impl tation, offering different ways of looking at and understanding process, 1 Perfect administration is the situation in which what is done is ‘what is supposed to be done. This is the ideal, against which other models are measured. It rarely works in practice. Implementation as policy management. The purpose of adminis- tay to find ways of translating policy into practice in the most effective way. In order to do this, negotiations may have to be undertaken, and judgments will have to be made, Implementation as evolution. The process calls for progressive refining and redefining of policy aims. Implementation as learning. Implementation is seen as a process of continual experimentation, searching and learning. Implementation as structure. This is a complex idea; the argument is that implementation involves a series of actors, ple in a single defined organisation, who can a unit for the purposes of explaining the process of implemen- tation, Implementation as outcome. Implementation can be seen as a process of interaction between policy-makers and implementers an issue in itself rather than just a means of putting policy into practice Implementation as perspective. The aim here is to understand the process from the point of view of the implementers rather than the policy-makers. Backward mapping. This is a ‘bottom up’ perspective, starting from the effects of policy rather than the explicit mn. The [process of implementation is understood by working back from the effects, Implementation as symbolism. Much implementation is dressed up in terms which may or may not relate to the actual policy; the study of this ‘political symbolism’ offers a different view of what is going on from a study of the effects. Implementation as ambiguity. Most policy processes leave loose ‘ends; policy and implementation have to be understood together, because neither in themselves will make enough sense for a clear interpretation to be possible.108 ‘SOCIAL POLICY: THEMES AND APPROACHES 11. Implementation as coalition. The process of implementation depends on the interaction of a number of different actors who form different coalitions in order to bring about particular effects Lane is critical of all of these models; many of them are vague, many offer only a partial explanation of processes, and none of them is sufficient in itself to offer a full explanation of the policy process. ° The issues and ‘processes will be examined more fully in the chapters which follow. Further reading A history of sociolegical analysis (London: Heinemann 1978). P. Bachrach, M. Baratz, Pover and poverty: theory end practice (New York: Oxford University’ Press 1970) offers an interesting and influential perspective on ‘nondecsions’. A. Cawson, Corporation end ‘wlfire (London: Heinemann 1982) specifically relates the analysis of corporatsm to wellare policy. ‘Much discussion of policy formation tends be theoretical and abstract. Attempts 1 policylimplementation distinction: the case of child abuse’, Policy 3), 1984, pp. 241-67. 8 | Delivering welfare ‘The social division of welfare ‘The role of the public sector ‘The private sector ‘The voluntary sector ‘The informal sector tate in welfare provision in practice: the planning of community care The social division of welfare Emphasising the political process, and the role of the state, tends to suggest that the state is central to the organisation and delivery of welfare. a half truth at best. The state is central to the establishment of policy, both because the state establishes a framework for the formal organisation of welfare, and because only in the state is there a locus through which conscious decisions can be taken to change or maintain the direction of welfare policy across a whole society the ability to take such ‘degree of negotiation between assured. Second, the state is not Provider of welfare services; there are many other routes through which welfare is provided. Titmuss identified several different kinds of redistributive process, arguing that it was not possible to understand the redistributive impact of .out taking them fully into account. He referred to a ‘social cluding three main types of welfare: ‘+ ‘social welfare’, which represented the traditional ‘social services’; this was the provision of welfare by the state 0?no SOCIAL POLICY: THEMES AND APPROACHES * ‘fiscal welfare’, which was distributed through the tax system; and * ‘occupational welfare’, distributed by industry as part of employ- ment." Titmuss’s concerns represented at the time a major extension of the traditional field of social administration, and the essay was enormously influential in broadening the definition and understanding of the subject, but the rationale behind it has never been wholly clear. If the ‘social division’ he described was intended to explain the channels through which istribution might take place, it was far from complete.* The calegory of ‘fiscal welfare’ could be taken to include two very different types of redistribution. The first concerns subsidies, or measures which are intended to have an effect on people's behaviour. Examples are housing, subsidies and mortgage interest relief. The second is income maintenance, ibute income and protect people's living , similarly, is not a single homogeneous employee creches; and private insurance, which is sometimes provided by employers, but may also be purchased by individuals. There are, besides, other avenues through which welfare welfare, which is compensation through courts); and, probably most important sectors. ‘The reference to ‘sectors’ leads to on« the contemporary study of social pol welfare services through a range of 80 e voluntary and the most important categories in which is the distribution of ‘mechanisms beyond the state itself. There are four main sectors through which welfare is provided: public, private, voluntary and informal - though, asthe previous discussion suggests, there isa case for considering more, The public sector consists of services provided by the sta ‘private’ sector, through commercial activity; the voluntary sector, action by non-profi organisations (thou to be ‘voluntary’); and informal care is provided by friends, neighbours and. families — or, more usually, by women in families. The role of the public sector The public sector is that part of the social services is financed and managed by the state: in some of the literature this is lentified with the idea of the ‘welfare state’, though this usage does not necessarily convey all the moral ideas which are associated with the term. DELIVERING WELFARE m Public services have been important not least because there are areas of social welfare in which there is no practical alternative, The model of residual welfare sees welfare as a safety net, which is only for people who are unable to deal with the contingencies in other ways. The protection of ‘welfare calls for an irreducible minimum of public services - a point acknowledged even by right-wing opponents of state welfare, like Hayek. The area of debate concerns not whether state welfare should exist, but what its scope and extent should be, and on what terms it should be delivered, ‘A number of the central arguments for delivery of welfare by the state — like issues of social protection and control - have been considered in chapter 5. State services can be seen, simply, as the means through which state policies can be pursued. The main outstanding issue is the question of ‘whether the public sector is the best or most appropriate medium through Which these social objectives might be achieved. The arguments are strongest in three cases: © where there are minimum universal standards to maintain, requiring either a general regime or residual provision to plug the gaps: where there are elements of control being exercised by the service, as in the case of protection of children in social work; and where there are subs economies of scale or effort in providing material through the state, rather than through fragmented services (for example, the considerable economies achieved by national health services) ‘There is an argument, too, for public services to step into the breach when other sectors fail; but that may be a reason for bolstering the other sectors rather than replacing them. None of the arguments about the public sector can be considered in isolation, because necessarily they refer to the performance of the state relative to the alternatives, The private sector Economic liberals argue that the private market is the best method of arranging the distribution of resources. Itis sometimes poor people cannot afford welfare. The reply to this give poor people more money, not necessarily to provi publicly. The best example in practice is the distribution o private market. If poor people cannot afford food, this is taken as a case for ‘more social security ~ not for a National Food Service. Arthur SeldonY SOCIAL POLICY: THEMES AND APPROACHES argues that the price mechanism leads to choice for the consumer; a service led by the consumer rather than by the professions; more efficient services lower costs (because this increases profitability); responsiveness to need. The main arguments against this position are based, arguments, in economics. The first set of problems relates to the social implications of depending on the private market Externalities, These are consequences which go beyond the people fed in a transaction: education is worth something to society may be reasonable for ss reasonable for society as ‘small, but in a society with 50 They may act as a “handmaide t or child abuse ~ be a form of social control. case of probation cond set of problems relates to the operation of the private market Economies of sale and efficiency. It may be cheaper to organise a large national service than it wve smaller competing services. The NHS has been able to reduce the costs of health care, by closing DELIVERING WELFARE a of services. The private market does not guarantee a cessary services. Services which are not profitable, because there are too few peopl ‘And the services which do exist are not n Pahl gives the example of two ice-cream planned economy, they would be given a ey have fre choice. This m Je. The next one also has to set up in the midal he is to get haf the custom.* The effect is a tendency for compe suppliers to concentrate their efforts in ane location. This does work in private welfare, too ~ which is one reason why major hospitals ‘were concentrated in central London before the NHS, and Hazley Street became a centre for consultants Choice. There are commodities ~ like health, and possibly education ~ which people are not well placed to choose, because they have no criteria on which to base their choice. Tt is in the nature of the commodity that its difficult if not impossible for a consumer to judge the quality and value of what is being provided. People actually have to buy insurance, not health care per se Coverage. Barr points to issues of ‘adverse selection’ and ‘moral hazard’ 7 Adverse selection occurs when insurance services excide ‘bad risks! ~ e.g. people with multiple sclerosis, chronic schizophre- nies, and elderly people — because the costs of providing for them are greater than the Service is prepared to bear. The problem of ‘moral hazard to contingencies which claimants might be able to control ~ like pregnancy or unemployment - and which insurance companies are consequently reluctant to cover. fon a beach In the private the first one 7 The voluntary sector The volunt societies to sector is extremely diverse, ranging from small local agencies. It covers a wide range of classification of charities in Britain he notes, to be hierarchically ordered and conservative in their orientation, while those working in housing and com- munity work are mainly participative in their organisation, and politically progressive.®ms SOCIAL POLICY: THEMES AND APPROACHES ‘This hardly begins to describe the range of activities which are encountered in this ‘sector’. Jones, Brown and Bradshaw classify the different types of volunteering as including direct service giving; running voluntary organisations (like the voluntary housing sector); participation ‘or stlFhelp groups; fundraising; public service ~ in the UK, magistrates and councillors are volunteers; and pressure group activity.” To some extent, the role of the voluntary sector is simply supplementary to Protection of Cruelty to Children does, have to be done by social work complementary, in a number of ways: of new approaches and 1@ development of specialised expertise, and the establish- ‘partnerships’ or contracts between voluntary and statutory tory service; they can criticise state services; and they ‘with state services, as in welfare rights work. than professional.!° The things may be done judgmen- to do administration. There are also tally; many volunteers are un problems in responsiveness where they are needed, but where people want to give agencies founded to meet the needs of one period usefulness; and agencies with a single aim can be inflexi resources. However, many of these criticisms could equally be levelled at statutory agencies. Mutual aid ‘There is a particular part of the voluntary (non-profit) sector which deserves special notice, because it has quite distinctive ¢ good case to consider this category as a sect ‘organisation and behaviour of solidaristic grox that of other non-profit organisations. Historica the main foundations of welfare organisations, through trades unions, and friendly societies in many countries, kind have continued to be one of the main {focuses through which welfare is provided.” The relative neglect of such arrangements in the English-speaking literature is difficult to explain — Beveridge certainly understood ‘voluntary action’ in these terms"®— though recently David Green has argued that solidaristic approaches offer an altemative both to the state and to the commercial sector."* professional associat solidaristic services DELIVERING WELFARE us ‘The central principle of mutual aid has been voluntary collective effort, which is both self-interested and supportive of others. People who enter such arrangements make some kind of contribution ~ such as paying a subscription, offering labour, or participating in management ~ and receive support on @ mutual basis. The most common model is probably a system of voluntary insurance, usually for income maintenance or health care, ‘which offers social protection in return for a basic contribution. But there are many other examples, including co-operatives, self-help groups, and The scope of mutual ad is considerable ~ the mutualist arrangements for health care in Israel cover nearly 90% of the population. The main limitation is that solidarity cannot be comprehensive: some people have a limited ability to contribute, and others are likely to be excluded by the conditions of membership. The informal sector ‘The ‘informal sector’ consists of communities, friends, neighbours and kin. ‘The discharge of people from institutions and maintenance of individuals in the community has led to a greater emphasis on the role of carers. The experience of community care has been to stress the limitations of the state and the public sector. Bayley made the argument, in respect of people with learning. disabilities ‘most care was not being provided by the statutory services, but by informal carers. The role of the state is, realistically, to supplement, relieve or reinforce the care given by others. This approach has led to.a range of criticisms. The social costs to carers need to be considered; while the economic costs are underestimated because they are not charged. Nissel calculates that, if costed in terms of income forgone and services rendered, informal care is massively expensive. Feminist writers have criticised the burden imposed on women. Pascall suggests that if a woman is present, the services will not offer support."” This is not strictly accurat ices reduce support if anyone else is present in a family, male orf jut where there are both male and female present, practice normally be the female who incurs the extza responsibility of care. The situation is arguably no better from the point of view of recipients. Service to dependent individuals ‘unexamined; there is no guarantee that informal carers will offer the best Welfare pluralism ‘The study of different sectors makes it clear that the state does not operate in isolation; rather, it acts in conjunction with a number of non-statutoryM6 SOCIAL POLICY: THEMES AND APPROACHES organisations. In the days before ‘welfare states’, charities and the voluntary sector were not necessarily as independent as they might have appeared; the state often had an active interest in regulation and support of their activities.”” The commitment of post-war states to welfare may have given the impression that these relationships had been, or were in the ng supplanted; but in most industrial countries there is a of relationships between the state and the other sectors of ‘welfare, which has to be regarded as the normal pattern through which is organised and distributed.” is has prompted arguments about provision of welfare services from many different sources. The idea ‘mixed economy of welfare’ emphasises the diversity of the provision of welfare in society. Table 8.1 was originally based on work by Judge and Knapp; I have developed it further from an earlier vers ‘There are three basic, and powerful, arguments for welfare pluralism. is the the Diversity. The range of services offered, the kind of things which can bbe done, is wider with the contribution of different sectors than without them, Table 8.1: The mixed economy of welfare Provision Finance Public Prive __Valuniary Mutual oid Informal Palle Socal Private Delegated State Foster are services homes for agency sponsored departments elderly services motualt people regimes Prete Occupational Philanthropic Employer corporate welfare foundations sponsored worker” corpaisations (Charges to Residents! Private health Housing Bailing Childe consimersearefor cae assodation societies minding deri rents people National Heth Union insurance Maintenance pension fund Organisations Hospital Purchase of Religious Selhelp Family care friends services by wel groups voluntary” organisations organisations DELIVERING WELFARE w The welfare society. The second is a moral argument for the type of society we want to live in. Conservatives have emphasised the pluralistic nature of welfare; traditional conservatism stresses an ‘organic view of s 1 a series of interconnecting relationships, and the role of family and duty. Similar sentiments are shared by those on the left: Titmuss argued that the voluntary sector also has an important social role; it allows people to be altruistic. We had to become not only a ‘welfare state’ but a ‘welfare society’. The recognition of reality. The state does not, and cannot, provide all the welfare in a society. In practice, what the state does may be relatively minor in relation to the burdens of care experienced by informal carers, and the state's task is to complement and supplement this kind of care to the greatest degree possible. At the same time, some reservations should be made, Comprehensiveness. A pluralistic welfare society might not be able to respond comprehensively to need. Webb and Wistow are critical of the claims of the voluntary sector to be able to fill the gaps; they see continue to apply in a greatly snsion of solidarity suffers from a basic flaw; that the definition of people to whom we hold respons- ty also has the necessary effect of defining others as falling outside rea of responsibility. French social policy, which has emphas- the importance of solidaristic networks, has also tried to ‘emphasise the ‘insertion’ or integration into social networks of people ‘who are ‘excluded’ or ‘marginal’ but the existence of such people is al approach Solidarstic networks are highly differentiated, work very much more favourably for some 3 others. Where there is a concern with social {equality ~ thats, the removal of disadvantages ~ there is the problem that those who are poorest and least able £0 protect themselves are ly to be adequately supported by other of trying to complement and supplement provision, rather than to redress the balance, may be to commit such people to an inferior and stigmatised form of residual provision The role of the state in welfare provision ‘The state affects welfare through regulation, provision and planning. Regulation. The state establishes the rules and settings under which welfare services operate. Moran and Wood, writing about the control of medical18 SOCIAL POLICY: THEMES AND APPROACHES care, categorise four main Kinds of regulation: regulation of market entry (uch as who can become a doctor and where they can set up), regulation ‘of competitive practices (like advertising), regulation of market structures (through legal rules conceming what can be bought and sold), regulation of remuneration and prices.* Provision. The state can provide welfare itsel Snancng and empayeent of diferent saa much the same thing, because in both cases the state can effectively determine the supply of services of effective demand if it so chooses. However, there are some important differences. governments are convinced that direct provision Lunproductive, indirect provision allows a way round. The second is practical: the purchase of services on the private market makes it possible fo use the facilities of the market, in particular its responsiveness to demand, and there have been cases (notably in the provision of private residential care for elderly people) where the response rate has been very rapid indeed. Conversely, a government which elects to use the private market is subject to its constraints. It will have limited contro of effective supply and demand - what a government s prepared to pay for healthcare ’is usually much less than what a private citizen faced with pai or the prospect of death will pay. Tt ean influence supply both major buyer and by imposing constraints on suppliers, find itself acting as a guarantor to inefficient suppliers (oecause most social services cannot simply be allowed to go out of busines). ideological: where Planning, The state has a range of tools at its disposal. The state can use the power of purchase; it can decide where to place its resources. There are through subsidy and taxation; the state can offer financial incentives to undertake certain activities, and conversely it can tax activities which it does not want pet undertake. There are legal controls, for example registration and inspection, which can be used to limit entry to the market; and it can require some firms to offer services a8 a condition of operating in other fields (for example, by insisting that all employers should offer maternity pay). Government is often in a position to bargain and negotiate. One of the agri or commercial use, has a powerful effect on land values, Similarly, land values depend strongly on the infrastructure for construc: tion projects ~like roads and sewers; the construction of a road has a major effect on the potential, and the value, of different sites. The state has the option of taxing development land value which it creates; but it can trade DELIVERING WELFARE ne off the permission to develop against potential gains for the community. So, shopping centres might be required to provide communal facilities, like a leisure centre, as a condition for their permission.”” Welfare pluralism in practice: the planning of community care One of the areas in which the idea of welfare pluralism has been most influential has been in the development of ‘community care’. The implementation of community care relies strongly on the concept of the care ‘package’, an idea which is probably attributable to Bayley.”* Bayley argued, in the context of services for mentally handicapped people, the primary role in the provision of social services was taken, not by statutory services, but by the families; the statutory services had to be seen as contributors to a network of services. The provision of services became, then, not a matter of the state providing comprehensively for each individual, but the development of a range of alternative services. From this range, each individual could be offered a programme selected for that person. Bayley refers to this process as ‘interweaving’ state services with community supports currently the formation of the package is referred to as principle behind establishing a diverse series of options is robustness of planning for individual cases: a service for any individual can be selected from a range of available services, In theory, the advantages of this kind of approach are considerable. ‘© Itis based in a recognition of the limitations of existing services, and in particular of the services provided by the state. ‘The approach makes it possible to do something. If the issue is eds, then offering a ran to meet those needs. in be expanded. ‘= Iemakes it possible to plan services rationally and cost-effectively Mach of the literature on community care in practice has been concemed with costeffectiveness, not ( ten appears) in the sense of cost cutting, but in the sense of providing the level of service appropriate to the needs of each individual j z s 3 i z 3 3 2 : 2 i ople, but of each individual ~ which is view of the history of provision of rare management has been described as ‘the process of tailoring services to individuals’ need’ The idea of the ‘care120 SOCIAL POLICY: THEMES AND APPROACHES plan’ depends on operation the constraints of existing services, but the elements ‘each care plan of assessment, review of options, and selection of services allows (at least in __ theory) a high level of flexibility and responsiveness. In practice, however, the limitations are considerable. Care plans are necessarily based on available resources, which cannot be adapted flexibly to the needs of each individual; plans are more likely to be based in a set of fixed altematives between which choices have to be made. ‘Care planning’, it has been argued, ‘should not be seen as matching needs with services “off the shelf”, but as an opportunity to rethink service provision for a particular individual’.*° But the selection of the appropriate services is not ‘made, whatever the theory, on the basis that these services best meet the vidual patient. Plans have to be realistic, and the principal we selection of options is the type of service provided. ‘Take, for example, the case of a psychiatric patient who is about to be discharged from an institution. The patient has, like everyone else, a number of basic requirements, which will include ‘may or may not include domestic care, engagement in leisure activities, employment prospects, medical care; and, beyond this, a number of services specific to the issues around mental illness, including as necessary ‘monitoring, medication, certification, therapy or support. Some of these needs might be met by families, which is one reason why care plans are likely to depend on family support; but this assumes that both the fami and the patient will accept such a situation indefinitely, which is often the case. Some needs may be met by existing statutory services, ‘income, housing and social work, but here there are well-known problems: different priorities within the services (which are designed for the general Specialised services necessarily takes t group’. A service is developed to the range of options, or the number of places, for people with particular classes of need. One might, then, see developed as a special project a core and cluster unit for mentally ill people; a base for ‘employment for mentally handicapped people; or very sheltered housing, for elderly people. Services which are appropriate to the needs of client ‘groups can only be flexible within limits, An example of this kind of approach is in residential care, where ‘accommodation is provided together with a specific programme of services DELIVERING WELFARE 1a and specific kinds of staff. The Wagner report makes the case, appealingly, for the development of a range of services in which residential care is seen in the same light as community care, and progressively greater levels of support are given within different kinds of accommodation."' However, ‘because support is organised in relation to accommodation, there is an identifiable pattern of services associated with particular residential units. Some of the difficulties are practical ~ stemming from the pattern of building, organisation and staffing ~ but there are good organisational reasons why residential units should offer a specific pattern of services, in terms of administration, competence, and control. The planning of services is service but a set of alternative packages. This ranging selection of appropriate services, and it is not clear, from any existing structure of services, how packages of care can be devised. On paper, it may look as if it is possible to draw on a range of different services; the reality of welfare pluralism implies something different. The role of government in planning is to ensure a sufficient range of alt packages, rather than services from which packages can be constructed. a ‘range’ of| lend itself toa free Further reading Titmuss’s artde on the ‘Social Division of Welfare’ was a watershed in the the ‘mixed economy of welfare’, which have been one of in social policy in recent years. Initially the discussion