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Charging for the Social Services*

Published online by Cambridge University Press:  20 January 2009

R. A. Parker
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Extract

New or increased charges to the users of the social services are likely to be considered with greater interest in our present economic situation. It seems an appropriate time, therefore, to ask what purposes direct charges are intended to serve and whether, in practice, they live up to these expectations. Admittedly, it may be misleading to refer to ‘purposes’ in this way, since they will be interpreted differently by different interests. But we may gain at least an idea of the range of purposes that governments have in mind by looking at the introduction, removal or variation of charges. The same might be done at the level of local government in those spheres where councils act independently. Proceeding in this way I suggest that five main purposes may be identified. Briefly, these are: raising revenue; reducing demand; shifting priorities; checking abuse, and a symbolic purpose. I shall say a little about each of them and then draw two sets of conclusions: one about the overall effect of charges and the other about the circumstances in which changes in charges are likely to occur.

Type
Articles
Information
Journal of Social Policy , Volume 5 , Issue 4 , October 1976 , pp. 359 - 373
Copyright
Copyright © Cambridge University Press 1976

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References

1 Department of Health and Social Security, Health and Personal Social Services Statistics for England (with summary tables for Great Britain), 1974, tables 2.2 and 2.3. My figures refer to Great Britain.Google Scholar

2 Martin, J. P. and Williams, S., ‘The Effects of Imposing Prescription Charges’, Lancet, 3 01 1959.CrossRefGoogle ScholarPubMed

3 See Ministry of Health, Final Report of the Committee on the Costs of Prescribing, 1959 (Hinchliffe), p. 34.Google Scholar

4 Martin, , op. cit.Google Scholar His estimate was accepted as correct by the Hinchliffe committee on prescribing.

5 Although maternity cases are not a high proportion of total cases they are important because they consume about three times as many hours as the average case. See Government Social Survey, Hunt, Audrey, The Home Help Service in England and Wales (SS 407), 1970.Google Scholar

6 Judge, Ken, ‘The Social Services: Where the Money Goes’, New Society, 8 08 1974, p. 343.Google Scholar Referring to charges to old people for residential accommodation he writes: ‘…if costs rise faster than pensions then public expenditure on the personal social services will grow faster than would otherwise be the case, although service provision remains exactly the same. All that happens is that £X of public expenditure is transferred from one Department of Health and Social Security subprogramme (retirement pensions in the social security programme) to another (local authority personal social services in the health and personal social services programme).’

7 See my ‘Social Administration and Scarcity: The Problem of Rationing’, in Social Work, 04 1967Google Scholar, and in Social Welfare in Modern Britain, ed. Butterworth, E. and Holman, R., London: Fontana, 1975.Google Scholar

8 H.C. Debs, Vol. 495, col. 54.Google Scholar

9 H.C. Debs, Vol. 498, col. 963.Google Scholar

10 Report of the Committee of Enquiry into the Costs of the NHS, 1956, Cmnd. 9663, London: HMSO, p. 191.Google Scholar The committee added that ‘it would be unwise to abolish the charges for dentures so long as the acute shortage of dentists continues’.

11 Calculated from Ministry of Health Annual Reports. ‘Prior approvals’ comprised 80 to 90 per cent of denture work.

12 In this example the ‘solution’ was introduced after the peak of the ‘problem’ had already passed; how far this was appreciated at the time is unclear.

13 Calculated from Ministry of Health Annual Reports

14 Calculated from Ministry of Education Annual Reports.

15 Office of Population Censuses and Surveys, Social Survey Division, Bone, M., Family Planning Services in England and Wales, London: HMSO, 1973, p. 38.Google Scholar

16 See Report of the Ministry of Health for the year ended 31st December, 1953, Cmd. 9321, London: HMSO, p. 91.Google Scholar The report went on to add that the reduction was generally speaking most marked in industrial areas.

17 See, for example, Hall, A. S., The Point of Entry, London: Allen and Unwin, 1975.Google Scholar

18 See, for example, Government Social Survey, Hunt, Audrey, The Home Help Service in England and Wales (SS 407), London: HMSO, 1970.Google Scholar

19 For a good discussion of the difficulties of prediction see Logan, R., Klein, R. and Griffiths, D., ‘Paying for Medical Care’, Lancet, 26 09 1970.CrossRefGoogle ScholarPubMed

20 Calculated from Ministry of Health Annual Reports.

21 H.C. Debs, Vol. 498,. Col. 862.Google Scholar Crookshank's address to the Lincolnshire division of the BMA – quoted by Edith Summerskill.

22 H.C. Debs, Vol. 495, col. 379.Google Scholar

23 Op. cit.

24 I suspect that the parents of children in care sometimes cease to visit them when they become substantially in arrears with their contributions. The chance of rehabilitation may thereby be jeopardized.

25 For a much fuller discussion of this issue than is possible here see Edelman, Murray, The Symbolic Use of Politics, Urbana, Ill., University of Illinois Press, 1967.Google Scholar

26 H.C. Debs, Vol. 756, col. 1801.Google Scholar

27 The problem is that distinctions are not always drawn between gross and net revenue, nor is it always clear how far ‘savings’ are calculated as the sum of effects of charges upon both demand and revenue.

28 H.C. Debs, Vol. 498, col. 966 (my italics).Google Scholar

29 H.C. Debs, Vol. 444, col. 1609.Google Scholar

30 Idem.

31 Summary of the Provisions of the Notional Assistance Bill, Cmd. 7248, London: HMSO, 1947, para. 24, p. 7.Google Scholar

32 H.C. Debs, Vol. 495, col. 477 (Resumed debate on the Financial and Economic Situation, 31.12.52).Google Scholar

33 Quoted by L. Pavitt in the debate (16.1.68) following the Prime Minister's statement on public expenditure. H.C. Debs, Vol. 756, col. 2050.Google Scholar

34 Guardian, 17.1.68.

35 See Hall, P., Land, H., Parker, R. and Webb, A., Change, Choice and Conflict in Social Policy, London: Heinemann, 1975.Google Scholar

36 H.C. Debs, Vol. 495, col. 232.Google Scholar

37 But note the exception of the charge to parents of children committed to care.