Frequent increases in the real value of National Health Service (NHS) patient charges have been made since the Conservative Party's return to office in 1979. For those patients subject to these charges the increases have led to a substantial reduction in the level of subsidization of the cost of the service. The rationale for the subsidization of health care is shown to be unrelated to ‘ability to pay’ considerations. Consequently the ‘backdoor privatization’ of these services is inconsistent with the objectives of the NHS even though the Government has continually committed itself to these objectives. Alternative policies to increasing patient charges are suggested which would encourage the efficient use of NHS resources without compromising NHS objectives.

This paper asks whether where someone lives bears any association with their attitudes to inequality and income redistribution, focusing on the relative contribution of neighbourhood income, density and ethnic composition. People on higher incomes showed higher support for redistribution when living in more deprived neighbourhoods. People with lower levels of altruism had higher levels of support for redistribution in neighbourhoods of higher density. People living in more ethnically mixed neighbourhoods had higher levels of support for redistribution on average, but this support declined for Whites with low levels of altruism as the deprivation of the neighbourhood increased. Current trends which sustain or extend income and wealth inequalities, reflected in patterns of residence, may undermine social cohesion in the medium- to long-term. This may be offset to some extent by trends of rising residential ethnic diversity.

The concept of ‘parenting skills’ features large in professional, political and popular discourse on the role and responsibility of parents. This article explores what constitutes skills of parenting from the perspective of community health and social service providers, working with families deemed to be ‘in need’. It shows how the concept is drawn on to describe both the needs of women with whom they work and their own role in fulfilling some of those needs. It argues that ‘parenting skills’ are not only gendered, insofar as it is women as mothers who are more likely to be perceived as needing them, but that a lack of them might also be associated with marital status, age and place of residence. In looking at ‘parenting skills’ from the perspective of service providers in the context of their working lives, it is clear however that service providers, predominantly women, formulate a role for themselves in the face of poverty and poor housing which they feel powerless to change.

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.

Northern Ireland has been dubbed by the media as the ‘race hate capital of Europe’ and attracted recent international criticism after one hundred Roma families were forced to flee their homes following racist attacks. This paper examines the problem of racism in Northern Ireland from a number of perspectives. First, it considers the effectiveness of the Government's response to racism against its Racial Equality Strategy 2005–10 using performance criteria designed to track the implementation of the strategy. Second, it considers and empirically tests the assertion in the literature that sectarianism shapes the way in which racism is reproduced and experienced. Third, it explores racism at the level of the individual – which factors influence people in Northern Ireland to exhibit racist behaviour. Finally, the paper considers the likely policy implications of the research findings in the context of devolved government where addressing racism is part of a wider political imbroglio which has gridlocked decision-making within the power-sharing Executive of Northern Ireland.

Using detailed extracts from two life histories, this article examines the nature of the personal identifications that often underpin the commitment of welfare workers to their jobs. We explore the paradox that it is those identifications such as class and gender, mediated through individual biography, that fix the ‘self as object’ and that also provide us with the resources for self-transformation. In this respect, the article not only throws light upon the psychical and emotional roots of commitment to the other, but also upon some of the impasses ‘identity theory’ currently finds itself in.

This article's starting point is Glennerster et al.'s 1991 question in JSP, 20: 3 whether ‘the decisive break’ they then saw in British social policy represented ‘A New Enlightenment or a New Leviathan’. Evidence is produced from the policy arena of education and training (i.e., learning) to argue that the Learning and Skills Act due for implementation from 1 April 2001 represents an example of the latter rather than the former. The Act is a further step on the road from what was traditionally ‘a national system of education locally administered’ to a national system nationally administered. This is clearly seen when the post-war system of education and training established by the 1944 Education Act is contrasted with the new system of contracting out provision through agencies. In presenting this contrast the article is an exercise in ‘Learning Policy’, described as ‘a new area of social policy … [which] indicates the concerted approach that many governments in developed countries now take to integrate the reproduction of knowledge at all levels in the education institutions under their control with skill formation in training in and out of employment’ (Ainley, 1999, p. 9).

This paper examines some of the social and political implications of retrenchment and privatisation in British housing policy. It reviews arguments and evidence about residualisation in the housing market, the effects of consumption sectoral cleavages, and attitudinal ambivalence to welfare, in an attempt to understand the apparent absence of discontent about inequalities in housing. It is argued that recent trends have exacerbated social fragmentation and reinforced tendencies to political acquiescence.

Consideration of the income and social security needs of informal carers has remained conspicuously absent from discussions about ‘community care’. Similarly, carers have been more or less invisible in the development of social security policies. This paper reports on a study of the financial circumstances of a sample of working age carers, who were living with and providing substantial amounts of help and support to a disabled person in the same household. The study highlights first, the substantial work-related costs incurred by carers with full time employment; and second the financial dependency of carers without full time earnings, on their spouse, sibling or on the person being cared for. The implications of these findings are discussed in the light of recent developments in social security policies.

In examining the sex of beneficiaries of income maintenance programmes, several country-specific studies suggest a pattern of segregation between women and men in access to types of benefit. Men are more likely to be recipients of social insurance benefits, whilst women often must rely on means-tested programmes, and frequently their claims to insurance benefits are via their husband. This conclusion is re-examined through a comparison of insurance and means-tested programmes in the UK, the US, the Netherlands, and Sweden. The purpose is to determine, first, to what extent such a pattern of segregation emerges in the four countries and, second, what mechanisms operate to exclude or include women. The comparison reveals that the Swedish case deviates from the other three countries, and policy constructions inhibiting and promoting greater equality between women and men in access to social benefits are discussed. The results also have theoretical implications for dual welfare as an analytical framework and feminist thinking about the welfare state.

This article analyses the pre-reform Polish healthcare system, the theory of the recent reform, the early experiences, and the likely future developments. The reform aims to preserve a state-guaranteed egalitarian healthcare system while ensuring optimal use of resources by the introduction of market-type mechanisms. These mechanisms cannot function as intended while sub-national governments, which have little incentive to support restructuring, remain a vital part of the system. An even greater impediment to the proper functioning of the system is the practice of informal payments. Therefore, smaller than expected gains in efficiency and equity, together with demographic and technological pressures on health costs and a political and economic climate which is unlikely to deliver large increases in public spending, are likely to result in a more privatised and unequal health system than is intended.

This article examines why, despite similar general interests, institutional positions and political constraints, EU social NGOs find it so difficult to develop co-operative strategies except on the most fundamental issues. To demonstrate these difficulties the article considers the general reasons for and against co-operation between social NGOs and then examines the difficulties and advantages of collective EU social NGO action during the 1998 NGO funding crisis, Red Card protest and civil dialogue. The article argues that there is a fundamental desire for, and are benefits from, close co-operation between the EU social NGOs. However, due to the complex ‘context structure’ within which NGOs must operate, this co-operative impetus is constantly undermined. In conclusion, the article argues that social NGOs will remain weak and insignificant actors until the Commission/Parliament and/or the social NGOs can organise the complex context structure and allow co-operative strategies to emerge.

The Labour government has often argued that it is attempting to find a ‘third way’ in politics, appearing to take its inspiration from Anthony Giddens and, in relation to Labour's pensions policy, Giddens' notion of ‘positive welfare’.

Noting that the government maintains that ‘pensions are all about security’, and that it has declared the importance of this position throughout its reform of UK pension provision, this article critically examines the nature of the ‘security’ its reform is likely to deliver. Using the work of Giddens, it notes the importance of the concept of ontological security, and the relevance of trust to security. From this basis, and drawing upon the work of both Giddens and Niklas Luhmann, it goes on to consider whether the government's reforms of the three pillars of pension provision in the UK – state provision, occupational provision and personal provision – are capable of delivering greater security in pension provision.

It concludes that, quite apart from the potential criticisms of the conception of positive welfare itself, the government's apparent adoption of such an approach has failed to appreciate adequately the importance of ontological security to any understanding of welfare. As a consequence, it is suggested that the practical outcome is reform that is likely to create much less security in pension provision than either Giddens' approach, or indeed regular government pronouncements, might suggest.

There has been a raft of policy changes in the UK that are intended to help low-income families engage with the labour market. Drawing in part upon the findings of a small-scale qualitative study of the experiences of low-income working families, this article infers that the secular trend to working parenthood may, as matters stand, be experienced rather differently by secure middle-class families than by poor families. It may be that the former will benefit from policies to improve access to formal childcare, career breaks and time off when needed. The latter are more likely to remain dependent on informal childcare from other family members or friends and receive minimal concessions granted by reluctant employers. While benefits such as working families tax credit will help to secure the material needs of low-income working families, low-paid employment will remain no less precarious and it is possible that the insecurity experienced by low-income working families will increase.

The rise of the third sector has been a global welfare phenomenon. In China, the growth of social organisations has been a remarkable feature of the transitional society after the adoption of market reforms and political liberalisation. In its emergent welfare economy, the third sector has been hailed as a new growth point in social care as the state retreats from direct provision of welfare services. This article examines non-state care homes for older people in urban China based on a survey of 137 homes in three cities. It begins with a brief review of the theory of the third sector, non-governmental organisations and private markets in the production of welfare. This is followed by a discussion of third-sector organisations, markets and the state in the special context of China. The next section appraises the factors that contribute to the surge of non-state residential provision for the elderly. The final part of the article presents empirical findings on the development, key features and authority relations of 137 non-state care homes for older people. It is argued that their uniqueness marks them out as a special form of third-sector organisation in China's welfare economy.

This article provides new evidence on the relationship between benefit conditionality and mental health. Using data on Temporary Assistance for Needy Families policies (TANF) – the main form of poverty relief in the United States – it explores whether the mental health of low-educated single mothers varies according to the stringency of conditionality requirements attached to receipt of benefit. Specifically, the article combines state-level data on sanctioning practices, work requirements and welfare-to-work spending with health data from the Behavioral Risk Factor Surveillance System and evaluates the impact of conditionality on mental health over a fifteen-year period (2000 to 2015). It finds that states that have harsher sanctions, stricter job search requirements and higher expenditure on welfare-to-work policies, have worse mental health among low-educated single mothers. There is also evidence that between-wave increases in the stringency of conditionality requirements are associated with deteriorations in mental health among the recipient population. It is suggested that these findings may reflect an overall effect of ‘intensive conditionality’, rather than of the individual variables per se. The article ends by considering the wider implications for policy and research.

Constitutional change offers the opportunity for a major departure in the nature and direction of policy, practices and governance in social policy. This article explores some of the impacts devolution has for the discipline of social policy, suggesting that devolution matters for social policy as a field of research and study, and for the analysis and understanding of developments in UK social policy. It argues that devolution has a number of implications in terms of comparative and transnational social policy, new sites of analysis, the language of social policy, the production of knowledge and the development of new policy communities within the UK. It also signals new perspectives based on evolving welfare subjectivities and around questions of territorial justice. Drawing on discussions about the nature of social policy in the 1970s in particular, suggestions are made as to how new and emerging perspectives within and across the nations of the UK serve to ‘decentre’ the social policy tradition. In essence, this article seeks to open up a debate for ‘theorising’ the discipline of social policy through a focus on devolution.

Elementary textbooks in a subject may well influence students more than their subsequent reading, and they show the basic assumptions of teachers. This article is based on a study of introductory reading recommended to social administration students in British universities and polytechnics in 1976. It argues that many textbooks incorporate to some extent an ideal-typical interpretation of social policy which is called ‘the social conscience thesis’. The first part of the article sets out to establish that this approach, which was one of the dominant ones in social administration, remains influential. It is still the most common interpretation of social policy at the elementary level. The article is not concerned with advanced and specialized texts, where, although the social conscience thesis is still strong, different approaches are more commonly found. The second part then attempts to explain why this approach was once so powerful and why it is still with us.

As unemployment has risen, so has academic, professional and political interest in its possible social consequences. In recent years a large number of studies have sought to prove—or disprove—that unemployment causes ill health, with few definitive results. This paper reviews the methodological and conceptual difficulties experienced by researchers in this field. It concludes that, generally, the impact of structural factors on the shape of the analysis has been all but ignored. It suggests that an historical perspective provides useful insights into the question and ought to be given more attention.

The debate on privatisation is central to social policy, yet it tends to generate more heat than light as definitions and operationalisations of ‘privatisation’ are often implicit, unclear and conflicting. This paper aims to explore the extent of privatisation in the NHS over three periods of government through the lens of three approaches of Mixed Economy of Welfare, Wheels of Welfare and Publicness. All have two dimensions of provision and finance in common, but Mixed Economy of Welfare and Publicness stress the third dimension, that of regulation, while Wheels of Welfare stresses decision. All three approaches agree that some policies in the NHS constitute privatisation, but there is some disagreement largely stemming from their differential stress on regulation or decision. It is important to introduce a degree of transparency in the debate which provides clear definitions and rationales. However, all approaches require further development which focuses on the important but neglected point of how different types of privatisation lead to different impacts on patients.