It is often claimed that before the NHS areas with the highest need for health care had the least provision. In other words, it is asserted that the so-called ‘inverse care law’ (Hart, 1971) existed. This claim is empirically tested for the hospital sector, using needs and provision data from a number of sources. It is found that, for the voluntary hospital sector, both beds and staff were inequitably distributed. However, for the municipal hospital sector, it appears that high need areas tended to have more beds and staff than low need areas. When both sectors are aggregated to produce total provision there is little association between need and bed provision, but inequitable provision for staffing. Thus, it is concluded that municipal provision was successful to some extent in rectifying the inequitable nature of voluntary provision.

This article argues that dominant paradigms in the study of social welfare have neglected the role of creative human agency in responding differentially to threats of welfare across the lifespan. This is due to the preference for unitary categories of analysis which place vulnerable individuals into homogenous groupings and to the tendency to work with limited models of vulnerability and helpseeking. These paradigms are further characterised by a preoccupation with pathological views of health and welfare and by inadequate conceptualisations of mediating factors and coping across the life course. A new paradigm of welfare is called for, the focus of which would be on the differential nature of vulnerability and risk among individuals and their differentiated reactions to threats to welfare. Directions for empirical research within such a paradigm are outlined.

The Beveridge Committee of 1942 is often assumed to have based its proposals for social security scales on a poverty line at the ‘human needs’ or social participation level. This is because of its ‘principle of adequacy of benefit in amount and time’. Using the Committee's working papers, this paper describes the discussions of the committee about the ideas of need and measures of poverty to be used. The evidence shows that the Committee knew very well that its proposed benefit levels were not enough for social participation. Because it consciously implemented the principles of minimum subsistence and less-eligibility in the face of inadequate wages, the proposed scales were arguably more austere even than Rowntree's ‘primary poverty’ standard which both he and Beveridge acknowledged was not sufficient to meet human social needs. Whether muddle or mendacity, this mystification has had serious consequences for the poor in Britain.

This article attempts to describe a major debate in turn of the century social reform through a close reading of the published works of Charles Booth, J.A. Hobson, William Beveridge, A.C. Pigou and others. My aim is to reconstruct the emergence and elaboration of a theory of labour market disorganisation, understood as the absence of effective norms governing employment relationships in urban labour markets subject to chronic over-supply. In so doing I shall take issue with a tendency in the historiography of social policy to fragment this debate into the development of two distinct conceptual frameworks corresponding to the social problems of poverty and unemployment more or less as we know them today.

This study identifies the general structural, political and institutional configurations which conditioned the emergence of national health insurance in Finland. Due to late industrialisation, the Finnish case allows the evaluation of the importance of the agrarian versus working class interests in the emergence of the Scandinavian model. The study also seeks to answer how the contending theoretical approaches of the development of the welfare state serve to explain the characteristics of Finnish sickness provisions. After the historical overview, the results of the historical processes are examined by comparing the quality of Finnish sickness insurance with the Swedish, German and British cases, each representing different ideal types of the modern welfare state.

British debates on citizenship often start from an examination of the important work of T.H. Marshall (1950). This paper is no exception. It is argued that Marshall confuses ‘rights’ and ‘opportunities’ within his notion of civil rights. This critique is then developed in terms of Titmuss' concept of the ‘social division of welfare’ so as to distinguish different routes to welfare in old age. A distinction is made between a civil opportunity route to occupational pensions and a social rights route to a state earnings related pension. This distinction is then elaborated to tease out some social class and gender dimensions of citizenship and inequality in old age from a life course perspective.

This paper, based on an exploratory study of households in an English south coast town, argues that main income source is a significant factor to be taken into account when distinguishing between households. The research was triggered by information drawn from the 1981 Census showing that less than half the population of Great Britain experienced a direct relationship between current paid employment and income. It suggests that generalisations based on an assumption that household income drawn mainly from paid employment is the norm, marginalise more than half the population. The study draws attention to some of the issues highlighted when the focus of research is on sources of income. These are presented as supplementing, rather than negating, views from other perspectives. This exploratory study highlights additional insights having implications for social policy, while acknowledging that each merits more detailed attention.

The paper looks at the relative importance of state benefits, employer benefits and private sources in supporting early retired men. Using data from various administrative sources, the General Household Survey and the Family Expenditure Survey, it shows how the increase in early retirement which occurred between 1979 and 1986 went hand in hand both with a greater reliance on means-tested benefits and a greater reliance on employer benefits. Although the income of the early retired was well above the minimum accorded by the ‘income support’ system, there were major differences between subgroups of the early retired—those dependent solely on state benefits and those with other sources of income, private and personal—and these differences have become more pronounced over time. Finally, the paper looks at the total costs of early retirement: to the state, to employers and to the early retired themselves. Total costs ballooned between 1979 and 1986. Much of the extra expenditure on benefits fell on employers, but the early retired themselves, through accepting a considerable reduction in their income, bore the bulk of the costs of early retirement.

The identification of the poor in this paper follows that of most contemporary applied work and consists of comparing a scaler indicator of welfare with a predetermined minimum level. The data is provided by the 1985 Family Expenditure Survey. Two measures of welfare are developed, one based on income which reflects the entitlement analysis of poverty and the other on expenditure, reflecting the standard of living. Households ranked very low by expenditure are considerably less likely to be ranked highly by income than vice versa. Further doubt on the rankings suggested by the income measure is provided by ownership of consumer durables. The expenditure measure suggests that the number of poor retired individuals is more than three times that implied by the income measure. The instability of the latter measure suggests that more confidence can be placed on assertions based on evidence employing the expenditure measure.

This paper studies equity in the distribution of primary health care and domiciliary care for elderly people. The main data source is the 1980 GHS which has been linked to local authority data. An equitably distributed service is defined as one in which only variables which measure respondent's need for the service provide a significant explanation of whether the respondent receives the service. In the case of primary health care we find that for a number of groups defined by gender and age, economic and demographic variables have significant explanatory power. For two groups (males under 41 and females between 40 and 60), need was the only significant variable. For domiciliary care not only are variables which relate to the respondent's demographic and economic status significant but also variables which are concerned with local authorities' policies concerning supply. In general neither service is distributed equitably in the sense defined.

In an era characterised by vast unemployment it is widely believed that certain categories of people are essentially ‘unemployable’. In most Western European countries, for instance, immigrants and other minority groups are considered to belong to the ‘hard core’ unemployed. While standard methods of the employment service have largely failed in assisting such individuals, a new method has been developed in the Netherlands referred to as the ‘tailor-made’ method. This article summarises research findings on the characteristics and suitability of this method. The findings contradict the myth of the ‘unemployable’ people.

Co-residence between adult children aged 35 or more and their elderly parent(s) or parent(s)-in-law has been investigated using data from the Office of the Population Censuses and Surveys (OPCS) Longitudinal Survey and the 1985 General Household Survey supplement on informal carers. Overall 4 per cent of adults lived with a parent or parent-in-law but this proportion varied considerably with age, marital status and gender. Socio-economic differentials in co-residence were also found. These suggested that where the child is the provider of support to an elderly parent co-residence may be associated with socio-economic advantage. Differentials in co-residence rates and differences between co-residence data from the Longitudinal Study (LS) and data on co-resident carers from the General Household Survey (GHS) also point to the important role of elderly people as providers of support to adult children. In conclusion, the implications of these data for policies of community care are considered.

As a result of changes to the financial regime for housing associations, affordability has become a major issue of debate in social rented housing in Britain. This paper assesses the implications of trying to construct a finance system for housing associations based on a regime of ‘affordable rents’ and the ‘safety net’ of Housing Benefits but with the state declining to define the central concept of affordability. Using examples of a number of Western countries, and empirical evidence from the sector in Scotland, the present position is criticised, and a route out of the policy vacuum is suggested. This is founded on the premise that housing is a means rather than an end, within a broader social policy. Given the political constraints, one solution lies in studies of the expenditure patterns and standards of living of different groups of housing association tenants, and in the creation of a sector-specific organisational subsidy to be available in addition to the usual producer- and consumer-subsidies.

School meals today are provided on a compromise basis; some pupils are charged and others are not. The compromise thus rejects two types of universalistic principles: allocating private benefits by the market and provision of merit goods collectively free of charge. The article examines, empirically and conceptually, the changing meaning of school meals; the demand and supply of school meals and the allocation of public subsidies to non-needy children; conflicting goals of expert nutritionists, egalitarians, redistributionists, efficient managers, and parents and children. The article concludes by considering political constraints on rationalising the programme in the name of universalistic principles. These constraints include the inheritance of commitments from previous governments, collective responsibility of spending and Treasury ministers; intra-party divisions between frontbench and backbench MPs; and low political salience of charging as an issue.

This paper aims to investigate the extent to which education reform in Northern Ireland has developed along separate lines and to comment on the degree to which a part of the UK can move independently with respect to key social policies. The next section will examine in more detail the unique features of education in Northern Ireland, following which it will discuss the main elements of the legislation. In doing so, we will draw comparisons with the themes underpinning recent developments in Britain.

Many of the principles of the Community Care White Paper (DoH, 1989) bear a striking resemblance to the Welsh mental handicap strategy launched six years earlier (Welsh Office, 1983). This paper considers the lessons to be learnt from the Welsh strategy for the development of needs-led services as promulgated by the White Paper. Similarities and differences between the two policy initiatives are first identified before considering the conceptual basis of needs-led services. Attention is drawn to two interdependent dimensions of needs-led services, user participation and management delegation, as a means of depicting three underlying models, each with different value stances. By drawing from a case study of one area in Wales, an attempt is made to test the expectations for needs-led services in terms of local planning and management requirements of the three models against the experiences of those charged with putting them into practice. Implications for the White Paper are explored in connection with user involvement strategies and assessment and care management processes.

A decline in the number of young people entering the UK labour force has led to growing interest in the recruitment and retention of women workers. As yet the child care needs of school age children have not been addressed. Using interview data the strategies mothers employ to meet their work commitments outside of school hours and during childhood illnesses are described. Although mothers remained the main carers of their children, they frequently depended on unpaid help from relatives. These informal arrangements were sometimes complicated and potentially vulnerable. This dependence on informal support networks has a range of policy implications.