Introduction

From late 1941, Titmuss was engaged in researching and writing Problems of Social Policy, published in 1950. This was part of the ‘History of the Second World War: United Kingdom Civil Series’. Intriguingly, ‘Problems of Social Policy’ was the title of a passage in a 1932 work by Tawney. It was originally planned that Titmuss write two volumes on the wartime social services. In January 1951, he told a government official that the second was due later that year, and he would send him a draft when revisions had been made. But by this point Titmuss was fully occupied at the LSE. In a letter to the School's director in late 1951, Titmuss complained about his workload. Consequently, he had had ‘to shelve indefinitely editorial work on the second volume’. By the summer of 1952, Titmuss had thrown in the towel, telling another government official that Margaret Gowing was taking over. He had been ‘reluctantly forced to give it up owing to extreme pressures of work here. I am finding that there are limits to human endurance!’ The book which ultimately appeared had an introductory chapter by Gowing, but the principal authors were Sheila Ferguson and Hilde Fitzgerald. In a generous preface, Hancock noted that it had initially been envisaged that these two would work alongside Titmuss. But ill health, and the ‘pressure of University duties’, had led the latter to resign as principal author. Nonetheless, he had ‘continued to give assistance to his two colleagues, and the book they have now completed conforms closely to his original plan’. The volume itself made frequent references to Titmuss's earlier work. As his correspondence suggests, Titmuss was not averse to letting others know how much he had to do, a habit maintained for the rest of his career. While Titmuss's volume was not published until 1950, it is appropriate to deal with it here as it dominated his life for most of the 1940s.

The trials of authorship

The Civil Histories series arose from the deliberations, in mid-1941, of the Cabinet committee responsible for the War Cabinet's Historical Section.

Introduction

This chapter examines Titmuss's political activism in the 1930s, a difficult decade for British society, and into the early part of the Second World War. Throughout the 1930s fear of another war was ever-present, and the Depression after the 1929 crash further exacerbated socioeconomic disruption in the ‘traditional’ industrial areas. A sense of foreboding was compounded by psychological ideas which stressed the irrational, unconscious, dimensions of human behaviour. For instance, the psychiatrist John Bowlby and the Labour politician Evan Durbin co-authored a book entitled Personal Aggressiveness and War which discussed, among other things, what they described as ‘irrational acquisitiveness’. Titmuss and Bowlby were already acquainted by this point, and their paths were to cross on various occasions over the coming years. Both were to be signatories, for example, to a letter to the Prime Minister in 1965 on the extent of child poverty. Titmuss, too, was concerned with ‘acquisitiveness’, and saw psychological factors as contributing to international conflict. Gloom and doom, though, was not the whole story. Compared to continental Europe, Britain was politically stable, with the National Government, dominated by the Conservatives, elected in 1931, and returned to power in 1935. Some parts of the country, including London, saw the development of new industries, and new ways of living characterised by improved living standards leading to higher levels of home ownership, and the acquisition of new consumer goods. Yet this, in turn, highlights significant regional differences, and, overall, there was a highly charged political and cultural atmosphere. It was in this unsettling environment that Titmuss became politically active.

The Liberal Party and the Fleet Street Parliament

In spring 1932 Titmuss was welcomed into Hendon Young Liberal Association by its honorary secretary, J.M. Henderson, who told him that Liberals were ‘few and far between in Hendon, but we are very keen’. This would appear to be the J.M. Henderson who, a few years later, was to become Titmuss's literary agent, acting on behalf of the company Stephen Aske.

Introduction

Throughout the 1960s Titmuss engaged in an acrimonious dispute with the Institute of Economic Affairs over the market's role in healthcare provision. More positively, this ultimately resulted in one of his most significant works, and last major book published in his lifetime, The Gift Relationship. Here, as well as dealing with the mechanics of the acquisition and use of blood for medical purposes, Titmuss sought to articulate, as advertised on the cover of the first edition, his ‘social philosophy’. For Titmuss, the contrast between the British and American methods of securing blood was marked. The former rested on voluntary donations, and for proponents of altruism in welfare this situation was truly exemplary. Donors gave their time freely, donated their blood at no charge, and could not know who might receive their donation – an instance of the kindness of strangers. Voluntary workers, too, were an important part of a system which existed within a necessary framework of universal healthcare provision. In America, blood was often sold by impoverished donors to for-profit blood banks, arguably laying blood supplies open to contamination, and to potential shortages. The British system was thus both morally superior and more efficient. As we saw in Chapter 24, The Gift Relationship had an impact on American opinion and policy, something returned to below when considering the book's reception.

Early skirmishes

In spring 1963, Titmuss's ‘Ethics and Economics of Medical Care’ appeared in the first edition of the journal Medical Care. Titmuss was involved in this publication's creation, a member of its editorial board, and had participated in its inaugural press conference, agreeing to say ‘a few words from the “social” point of view. He clearly saw Medical Care as a suitable outlet for his ideas on healthcare and the market, a feeling which was reciprocated. The editor, Dr Abraham Marcus, told him that he was ‘very glad indeed that you are going to write on the subject’. In his article, Titmuss noted the introduction of Britain’s ‘free-on-demand health service’ in 1948, something which was not ‘in its essential principles a novel event’, given historical precedents. However, in the work of economists associated with, especially, the IEA and the American Medical Association, the NHS was now regarded as ‘a unique aberration’.

Introduction

The expression ‘welfare state’, which Titmuss disliked, is problematic, not least in implying planned, integrated services. But this has never been the case. To take the example of the NHS, in Titmuss's lifetime this had a tripartite structure whose three components were the hospital service, primary care, and local authority services. All this was troublesome from the outset because of, for instance, the different geographical boundaries used by each part. To focus on local authorities, these had retained responsibility for public health, under the supervision of a Medical Officer of Health (MOH). Among local authorities’ other responsibilities were the personal social services, education (including the school meals and medical services), and housing. They varied, moreover, in their political composition, and potentially in policy implementation. Add to this that Scotland, Wales, and Northern Ireland had, to varying degrees, their own organisational structures and welfare cultures, and it will be evident that the ‘welfare state’ was far from a centralised, monolithic institution. Against this confusing background, this chapter examines Titmuss's involvement with changes in Scottish social work and, contemporaneously, with the Seebohm Committee, set up in late 1965 to review local authority social work services in England and Wales. Titmuss viewed both these developments as broadly positive, and as having wider implications. As he told the first meeting of the Social Administration Association in 1967, in a speech seeking to clarify further his field's scope, the ‘problems of how to teach social administration in non-specialist as well as specialist ways will receive added force’ when, alongside other policy developments, Seebohm reported, and the impending changes in Scottish social work took effect.

Scottish social work

Titmuss contributed to the Scottish White Paper on Social Work, precursor to the 1968 Social Work (Scotland) Act. This put social work in Scotland on a different path from elsewhere in Great Britain, notably through the creation of Children's Panels. These effectively took offending young people out of the adult justice system, and more directly into social care. The Act also integrated all existing welfare functions for children and young people. The need for an investigation into Scottish social work had been prompted by the findings of the Kilbrandon Committee, published in 1964, which had investigated juvenile delinquency.

Introduction

Titmuss, despite his ever mounting commitments, was generous with his time, and this applied to other academics, both junior and well established. This chapter examines his support for American scholars working on British subjects. This could take the form of, for example, advice on sources, supplying suitable contacts, reading manuscripts, or facilitating a collaborative project. A number of the individuals involved were visitors to the LSE and, on occasion, Titmuss's home, and all went on to, or were already pursuing, distinguished academic careers in the US. While Titmuss undoubtedly gave his support for unselfish reasons, nonetheless the establishment of further contacts in American academia can only have added to his transatlantic networks. It is not suggested that the individuals discussed below were the only American scholars Titmuss aided. Rather, each illustrates the generosity of Titmuss's collegial approach to academic life, and the perception of him as an authority on social welfare. It is the case, too, that these Titmuss-inspired, or aided, works can be viewed as commentaries on American social policy, something with which Titmuss himself was intimately engaged, and the subject of the next chapter. Equally, some of Titmuss's comments further illuminate his perceptions of contemporary British society.

Social welfare: Heclo and Gilbert

We have already encountered our first recipient of Titmuss's support, Hugh Heclo, later Professor of Government at Harvard University, who had worked for Titmuss during the latter's membership of the Finer Committee. Titmuss had been instrumental in Heclo's appointment, and was clearly keen to promote the young American's career. Heclo dedicated his first major academic work, Modern Social Policies in Britain and Sweden, which came out shortly after Titmuss's death, to him and Kay. Below the dedication are the lines ‘we learned that in quiet places reason abounds, that in quiet people there is vision and purpose’. This (unattributed) quote comes from the liberal Democrat, and supporter of progressive causes in America, Adlai Stevenson, and so gives a sense of Heclo's own political position, as well reflecting his feelings about Titmuss and Kay.

Introduction

By the time of Titmuss's first American visit, the momentum generated by President Roosevelt's ‘New Deal’ of the 1930s had stalled under unsympathetic Republican administrations. Americans on the liberal left seeking to build on Roosevelt's legacy, then, looked to a rather different reform trajectory, that of post-war Britain, and to an individual, Titmuss, who was advancing, and reformulating, the field of Social Administration. In American academic life, meanwhile, there were no real equivalents of the department Titmuss was developing at the LSE. Proponents of social reform were often to be found in schools of social work, and in parts of the federal bureaucracy. America's highlevel public officials, though, were generally political appointments, which had implications for policy formation and implementation. America's ‘weakness’ in the academic field of Social Policy, at least in an institutional sense, explains why Titmuss was to be (unsuccessfully) head-hunted by American universities. Nonetheless, he did engage with American welfare issues, and this chapter focuses on his contribution to the ‘War on Poverty’ in the 1960s, with particular attention to his visits of 1962, 1964, and 1966.

Social welfare in 1960s America

In 1960 John F. Kennedy, a Democrat, won the presidential election. He was committed, half-heartedly, to measures of social reform. His assassination in November 1963 led to Lyndon Johnson taking over in the White House. Usually remembered for miring America in the Vietnam War, here what is important about Johnson was his other ‘war’, the ‘War on Poverty’, announced in messages to Congress in early 1964, and the associated attempt to build ‘The Great Society’. This was, historically, the high point of federal government activism. Johnson had come to political maturity during the 1930s, telling an advisor that he was a ‘Roosevelt New Dealer’. A range of reform programmes were undertaken during Johnson's presidency, including the 1965 Medicare and Medicaid Act. Medicare effectively expanded social security provision to create health insurance for the elderly. Medicaid, funded out of general taxation, provided healthcare for the needy poor.

Introduction

The last chapter examined Titmuss's political activities in the 1930s and early 1940s. Demanding as these undoubtedly were, Titmuss also found time for other forms of social and political engagement. Among his early research interests were population, and population health. He was convinced, as were many others at this time, that Britain's population was in decline, and that this promised problems for the future. Nonetheless, as Pat Thane puts it, Titmuss was ‘the most persistent, prolific, and one of the most immoderate demographic pessimists’ of the 1930s and beyond. We shall encounter this pessimism in this, and later, chapters. Titmuss was, further, concerned about population health, arguing that proper analysis of the rates of morbidity and mortality revealed significant class and regional disparities in health experience and outcomes. Such concerns led to membership of the Eugenics Society, his first major publication, and conclusions with serious implications, at least in his view, for Britain's preparedness for what was, by the late 1930s, inevitable war.

The Eugenics Society

The Eugenics Society (originally the Eugenics Education Society) was founded in 1907. It was a small but influential body campaigning for greater attention to be paid to issues of heredity and population quality. Among its members in the 1930s and 1940s were William Beveridge, and his successor as LSE director from 1937, the social scientist Alexander Carr-Saunders. Titmuss was introduced to the society in 1937 by the LSE demographer and refugee from Nazi Germany Robert René Kuczynski, remaining a member until shortly before his death. Kuczynski, who had published alarming predictions about population decline in Western Europe, had favourably noted Titmuss’s statistical skills. Titmuss gained further kudos with the Society when, a year later, he published Poverty and Population, which impressed, in particular, reform-minded eugenicists such as Carr-Saunders, Society General Secretary C.P. Blacker, and Lord Horder, the King's physician. The Society, it has been argued, appealed primarily to certain elements of the middle class. This can be construed to include both members of the professional middle class – doctors such as Blacker – and those, like Titmuss, from the ‘new’ middle class. Titmuss became an active Society member, and, in addition to its usefulness as a platform for his ideas, it gave him the opportunity, which he was not slow to take up, to gain important and influential contacts.

Introduction

In the course of the 1940s, Titmuss continued to play an active part in the Eugenics Society which, as we saw in Chapter 4, he had joined in the late 1930s. This was prompted by his interest in population and population health. But it likewise afforded him the opportunity to network with well-connected individuals who were to become important figures in promoting his career, such as Carr-Saunders and Hubback. This chapter examines Titmuss's work for the Society during the Second World War, especially from early 1942. He was editor of Eugenics Review for the first two editions of that year, standing in for Maurice Newfield while he was unwell. From the outbreak to the end of the war he also contributed six articles and a number of book reviews to the journal, as well as taking to task, in the correspondence columns and in debate, critics of his own approach to population issues. He participated in Society meetings, during the early part of the war was on its Emergency Committee, and by the end he was on its council, the latter an elected position. Titmuss published his third book, Birth, Poverty and Wealth: A Study of Infant Mortality, with Eugenics Society support. He was also co-opted, in 1943, onto the Population Investigation Committee (PIC), set up by the Eugenics Society in the mid-1930s.

Committee man, editor, and contributor

With the outbreak of war one immediate consequence for the Eugenics Society was that C.P. Blacker was called up to the Royal Army Medical Corps (RAMC), so depriving the organisation of one of its most active members and administrators. An emergency meeting of the council was called shortly afterwards. It was agreed to set up an Emergency Committee, chaired by Lord Horder, of ‘nine members able to attend regularly, with power to co-opt’, which would ‘act on behalf of Council for the duration of the war’. Titmuss was one of these, as were Carr-Saunders and Hubback. He was undoubtedly in favour of the creation of the Emergency Committee, telling Ursula Grant-Duff in mid-September that there was an overriding need to ‘see that the work of the Eugenics Society is kept alive’.

Introduction

This chapter starts with a discussion of Titmuss's only publication jointly authored with Kay, Parents Revolt, published in 1942. Titmuss later claimed that it had been ‘partly written in an air raid shelter in Pimlico’, the area of London where he and Kay lived. This work once again engages with Titmuss's major preoccupations of the 1930s and 1940s, his concerns about population, population health, and the moral implications of materialism, and was clearly intended to reach a wider audience than simply those interested in eugenics or demography. In this respect, Parents Revolt links more closely with the material discussed in Chapters 5 and 8. Further examples of Titmuss's interventions in these fields are then briefly discussed, before turning to the logical outcome of his interests in population health. This was the engagement by Titmuss, and Jerry Morris, with the emerging discipline of social medicine, and the subsequent creation of the Social Medicine Research Unit. It is shown that Titmuss and Morris were among the pioneers of social medicine in Britain, especially through the publication of what were to become foundational articles for the field.

Parents Revolt

The subtitle of Titmuss and Kay's volume, A Study in the Declining Birth-Rate in Acquisitive Societies, was revealing for, as we have seen, Titmuss was much taken with Tawney's notion of the ‘acquisitive society’. The book included a preface by the veteran Fabian socialist Beatrice Webb, who claimed that it raised, ‘in a series of brilliantly graphic chapters’, the ‘crucial question of the fall of the birth-rate, threatening the survival of the white race’. Rather than producing an academic work of demography the authors had, in a reference to wartime rationing, ‘preferred to use the short supply of paper to prove the fall in the birth-rate as a public danger’. Birth control had become increasingly available and, since the First World War, been practised by the working class. This was not least because of a labour market so hostile ‘that it seemed abject folly to produce children who could neither be adequately nourished nor sufficiently educated to secure a satisfactory livelihood’. But the authors also provided a solution to this problem, in essence the replacement of a competitive society by one driven by the principle, with Webb alluding to Marx, ‘From each man according to his faculty, and to each man according to his need’.

Introduction

After 1945, life expectancy in Britain continued to rise, partly because of the benefits of the ‘welfare state’, full employment, and the revolution in medical science. While the population as a whole grew, those over 65 years constituted a slowly increasing proportion of the total. In terms of welfare provision, the restructuring of the national insurance scheme in the late 1940s proved problematic. The value of the contributory pension, in any event designed as a subsistence award, was declining thanks to inflation. The scheme's flat-rate basis further exacerbated the issue of the pension's value. Many pensioners remained victims of poverty, and so were increasingly reliant on means-tested awards. The whole structure had shaky actuarial foundations in that pensions were paid for not by historic contributions but effectively by younger workers. Entitlement to a state pension came at 65 years for men and 60 for women, ages which had no particular economic or medical rationale but which were apparently fixed and inflexible. Although legislated for by a Labour government, there was nothing especially ‘socialist’ about the pensions scheme. Rather, it embodied Beveridge's liberalism.

Thus policy challenges persisted. The incoming 1951 Conservative government considered whether targeted, rather than universal, benefits were the way forward. And as John Macnicol points out, the 1950s saw a ‘small but growing lobby of free market opinion … arguing that state pension ages should be raised’. By such accounts, expenditure on pensions was ‘dysfunctional’ as it did not ‘invest in youthful human capital’. Rather, it ‘diverted resources to a non-working, unproductive section of the population’ which consumed, rather than produced, wealth. Titmuss became heavily engaged with these issues, coming to be seen as an expert on pensions policy, and in the 1950s in particular worked extensively on the subject. This chapter's aim is not to deal with every article or memorandum in an often abstruse and technical field. Rather, it seeks to show how Titmuss contributed to broader debates about the place of, and support for, old people in society.

The employment of older people

In 1951, the Conservative government set up the Advisory Committee on the Employment of Older Men and Women under the supervision of the Ministry of Labour and National Service.

Introduction

The 1960s saw student unrest across Western Europe and North America, and the LSE was one of the main British participants by way of what came to be called ‘The Troubles’. Titmuss did not approve. In April 1969 his old friend Margaret Gowing, now at the University of Kent, hoped that ‘things aren't as bad as they sound for you but I fear they probably are. It must be hard with departments and friends on different sides etc: presumably a complete civil war. I am sorry’. Titmuss replied that at ‘the moment most of us here are living from hour to hour – it really is hell’.The following month it was announced that David Donnison was leaving, as The Times put it, the ‘embattled LSE’, to take up another post. Donnison admitted to ‘feeling like the proverbial rat leaving the sinking ship’. But the School had not become ‘a more attractive place to work recently’, and he only wished that he ‘was leaving when morale was higher’. What was it that reduced Titmuss, and Donnison, to such despair?

Titmuss and students

Titmuss was justly famed for taking considerable care of his students at a time when this was not necessarily the norm in British higher education. While he could be disparaging about their middle class backgrounds, on a personal level he was kind, attentive, and supportive, and devoted to education in all forms. During his final illness, although in considerable pain, he went out of his way to maintain his teaching commitments as best as he could. In the October preceding his death, he told his second year students that he had been ‘deeply touched by those lovely flowers’ he had discovered on his return from yet another hospital stay. He would be back with them as soon as possible, and would share his experiences of the NHS. As well as having ‘hobnobbed’ with other patients, he had even been ‘allowed to have a seminar with students – nurses and medicare!’m Such recollections were to form the basis of the Postscript to the posthumously published Social Policy: An Introduction.

Introduction

Titmuss's working life was always a balance between what were, for him, the principal functions of higher education – teaching students and conducting and disseminating research – and engagement with the policy process. In his view, though, these activities were complementary, rather than existing in watertight containers. This chapter examines, first, the reception of his second collection of essays, Commitment to Welfare. Although based on existing writings, and subject to academic criticism, this book also had an explicitly educational function. Titmuss's detailed, practical, contributions to the Finer Committee on One Parent Families is then described. This work was challenging and complex, raising a number of important questions about the aims and delivery of social services.

Commitment to Welfare

Commitment to Welfare was published in 1968, in both Britain and the US. The American edition's front cover posed two of the questions Titmuss had addressed: ‘What can be done about the fundamental inequities of our society?’ and ‘How can our social policies benefit all sections the population rather than increase the power of the few?’ The volume consisted of 21 pieces, and the essays, or the lectures from which they derived, are discussed at appropriate points in this volume. So here we examine why Titmuss brought out this collection, and the reaction to it. As he explained, while most of the pieces had been published, some were not easily available. Consequently, students had difficulty in locating them, while Titmuss's secretary, the redoubtable Angela Vivian, was ‘sometimes over-strained by the flow of requests for offprints, typewritten copies and the like’. Titmuss's publisher at George Allen and Unwin, Charles Furth, had also employed his ‘gentle persuasiveness’ to bring the collection about. A similar rationale had been provided for Essays on ‘The Welfare State’. Commitment to Welfare was organised into four thematic sections. But this gave an ‘exaggerated impression of tidiness which I hasten to disavow’, as the more Titmuss tried to understand ‘the role of welfare and the human condition the more untidy it all becomes’. Among those thanked for their comments were Abel-Smith and Townsend and, from the United States, Eveline Burns and Ida Merriam. In an enigmatic turn of phrase, ‘the aid, subjective and objective, of my wife’ was also acknowledged.

Introduction

Titmuss's early life, unremarkable in many respects, has nonetheless been the subject of dispute. Shortly after his death Margaret Gowing, a friend with whom he had worked during the Second World War, produced an account of his life which has proved influential for how Titmuss has since been viewed. Gowing's narrative remains important, and will be drawn upon in what follows. In certain respects, however, Gowing’s was a partial account which consolidated the by then standard view of Titmuss's origins and career. Put simply, this stressed the deprivations of his childhood and youth, so throwing into sharp contrast his eventual place as Britain's leading authority on social policy, an expert advising governments at home and abroad, and public intellectual. For instance, a sympathetic profile in The Observer in 1959 noted the challenges Titmuss's family had faced, and how Titmuss himself claimed to have learned little at school, save an enduring love for cricket and football. A few years later, another newspaper article suggested that the origins of ‘The Poverty Lobby’ of the 1960s lay in the early hardships of one of its members, Titmuss. While colleagues such as Abel-Smith were middle class, and had come to socialism ‘by conviction’, Titmuss had reached this position ‘by experience’. The last point begs more questions than it answers, not least the nature of Titmuss's political beliefs.

In his application for the LSE chair in 1950 Titmuss said little of his formal education save that, ‘As the son of a farmer’, he had been sent to ‘a preparatory school in Bedfordshire which drew most of its pupils from farmers in the district’. At 14 he was then sent to Clark's Commercial College for six month to learn bookkeeping. The downbeat account of Titmuss's early years was most vigorously promoted by his wife, Kay. Shortly after his memorial service in June 1973, she told an American friend who had spoken at the event that Titmuss’s ‘only schooling was at a private school of poor quality from which he was frequently absent due to ill health in childhood’.