No major reform of the welfare state has a chance of going through unless one can make a plausible case as to both its ‘ethical value’ and its ‘economic.value’, that is, that it would have a positive effect in terms of both justice and efficiency. In this essay, this rough conjecture is first presented, and its plausibility probed, on the background of some stylised facts about the rise of modern welfare states in the postwar period. Next, the focus is shifted to the current debate on the introduction of a basic income, a completely unconditional grant paid ex ante to all citizens. It is argued that if basic income is to have a chance of meeting the strong twofold condition stipulated in the conjecture, some major changes are required in the way one usually thinks about justice and efficiency in connection with social policy. But once these changes are made, as they arguably must be, the chance that basic income may be able to meet the challenge is greatly enhanced.

Catholics are urged to show a ‘preferential option for the poor’. For the most part debate about the exercise of such an option is primarily in terms of a justice model—righting the twin wrongs of the ‘exploitation’ and ‘oppression’ of the poor. But there is another, largely untheorised approach to helping strangers in need—Samaritanism. This paper provides an exposition of Samaritanism and a defence of its role in the modern Welfare State. In doing so it seeks to challenge non-Christians to put their rationale for helping the needy on an equally secure footing as that provided by Christianity.

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, ‘in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great’. This paper examines the extent and causes of this ‘implementation gap’ in respect of services for people with mental handicaps—a consistent priority group for national policymakers. We examine centre–periphery relations in the health and personal social services in the light of Rhodes' power–dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.

Citizenship is, once again, on the political and academic agenda. This article explores some of its meanings for women. It examines some of the contradictions raised by notions of dependence and independence and the relationship between ‘private’ and ‘public’ forms of dependence. It then considers the implications of financial dependence and of the sexual division of labour and of time for women's rights and obligations as social, political and ‘active’ citizens. It concludes by drawing out briefly some policy implications, arguing that radical changes are needed in domestic life and in the organisation of paid employment and state provisions, if women are to be full citizens. This will require changing both our conceptions of Citizenship and the structures which fashion citizenship rights. Ultimately, neither the question of dependency nor of citizenship can be divorced from that of power.

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.

It has never been easy to conduct research into currently sensitive policy issues, but there is now accumulating evidence to indicate that various forms of resistence to scholarly investigation are on the increase. Such a climate handicaps all social policy research, but may have the greatest impact on ethnographic projects. Yet, it is argued, ethnography is increasingly widely recognised among academics as having a particularly valuable contribution to make to the study of the policy process. Unfortunately, many policy practitioners (and occasionally some academic colleagues) perceive ethnographic research as being of questionable validity and low helpfulness. This behoves policy-oriented ethnographers to demonstrate that they do indeed have procedures for assuring validity, even if their style of investigation is never likely to be popular with government.

This paper examines the current model of sheltered housing and explores a central contradiction in that model: namely that if only those people who most need and appreciate the unique features of sheltered housing were allocated places in schemes, the existing model ultimately could not provide sufficient support. This central contradiction leads to a fundamental lack of clarity in the role of sheltered housing. This is reflected in the ambiguities apparent in allocation practices, where judgements are typically made not only in relation to the tenants' needs and demands but also in relation to the impact on schemes. Evidence is presented from a recent study of sheltered and amenity housing in Scotland, which exposes these issues and suggestions are made as to how the traditional model of sheltered housing can be made more flexible and more suited to those who need and value it most.

This paper is concerned with the work of child care and with the division of work between mothers and others. Drawing on research data, it explores the idea that this work takes place in a domain located between the public and the private. The perspectives of mothers and health visitors on child care and health care are considered, with particular reference to their perspectives on their own and others' knowledge and responsibility.

The core of this paper is a case study of how a District Health Authority (Paddington and North Kensington, now Parkside DHA following a recent merger with Brent DHA) in Inner London responded to a major new health care issue of the 1980s—Aids, but the paper also seeks to locate this case study material within wider debates. What theories are there of organisational change which could be used to illuminate policy and service change in the health care sector? How, indeed, do we best study change in health care organisations? The paper is thus in three parts. In the first section we identify some streams of literature which act as a frame of reference defining our initial research question and discuss implications for methodology. The second section presents the case itself, while the last section discusses some emerging findings.

In the United Kingdom a range of services for elderly people in the community has developed that is delivered by a variety of professionals and administered within different organisations. This has resulted in a problem of co-ordinating services to meet the individual needs of the most frail elderly people. In the United States ‘case management’ has been introduced as a way of improving the co-ordination of care. Despite structural differences in the provision of health and social services between the United States and the United Kingdom, the concept of case management has influenced the design of a number of innovatory schemes in the United Kingdom, including the Gloucester Care for Elderly People at Home project (CEPH). These innovatory schemes have demonstrated the need for a ‘keyworker’ and clarified the tasks that are involved in taking responsibility for co-ordinating services to meet the needs of elderly people at risk of failing to cope at home. There is, however, a danger of proliferating the complexity of service provision by creating a new breed of professional; an alternative might be to alter the responsibilities, attitudes and team orientation of existing professional workers so as to include taking on the key worker role for some of their clients.

The shift from national insurance to employer administered, state funded Statutory Sick Pay has been discussed in terms of the privatisation of social security and its impact upon the living standards of sick-absent employees. This paper reports a survey of employers’ perceptions of the change. Many employers have seen the introduction of the scheme as an opportunity to extend control of sickness absence among workers. The new regime may be better understood as part of a process whereby the government and employers link together to manage labour in the interests of capital, rather than as the privatisation of one aspect of social security.

In 1969, the British Government established the Finer Committee to consider ‘the problems of one parent families in our society’. Its report, published in 1974, concentrated on the economic circumstances of these families, though it also looked at other issues including the welfare implications for children. Since then there has been further research in Britain focused on the economic circumstances of one parent families and continued interest in the health, welfare and development of children in these families. What was missing from the deliberations of the Finer Committee and is still omitted from subsequent research activities, is any substantial consideration of the health and welfare implications of lone parenthood for the adults involved. Yet such research is important. Firstly, one parent families are a numerically important group amongst British families caring for dependent children and it is predictable that they will continue to be so. Secondly, research into the social and economic circumstances and the health experience of lone parents, is also essentially research into the nature and causes of gender inequalities, because lone parents are disproportionately female. Finally, research into patterns of health and illness amongst lone parents would also be relevant to those planning a range of health and social services. This paper therefore seeks to contribute to knowledge about the health status of lone parents. Using data from a national annual household survey (the OPCS General Household Survey) we describe the subjective experience of health and illness amongst lone mothers and fathers. This is compared to the experience of parents in couple households and of different groups of lone parents according to sex, marital status, socio-economic circumstances and ‘normative’ gender roles in order to explore the relative importance of this group of factors in the aetiology of the patterns described.

A changing socio-economic environment and competition have led trade unions to extend their role and become service providers. This paper examines some of the issues of service delivery which arise. Four central implications are discussed: the trade union's need (1) to adapt to the competitive service provider's market, (2) to enlarge its consumer body, (3) to become an employer of workers, and (4) to expand its interests with business establishments and authorities over non-union matters. The paper focuses on the General Federation of Labour in Israel (the Histadrut), and its comprehensive health insurance scheme (Kupat Holim). The scheme is provided to all union members and their families as part of union membership. Nonetheless, alternative service systems seem sufficiently attractive for many union members to consider ‘deserting’ their union. The union depends on its members—consumers—to secure its broad base, universalistic image, source of income and legitimacy. Trying to attract consumers causes the union to bend some of its principles. Ultimately, service provision forces the union to adopt characteristics alien to, and even contradicting, its traditional, militant role as an organiser of labour.

Community schemes play an important part in a community approach to social work. This paper investigates the extent to which social workers' involvement in such schemes is influenced by personal preference or by their work setting. Data from questionnaires completed by 394 social workers/social work assistants show that the likelihood of a worker's involvement with a scheme varies with the organisation and procedures of the area office, the perceived attitudes of team leaders and the title of the worker's job. Workers' personal attitudes were related to involvement in schemes only in area offices organised on a geographical basis. The paper discusses the implications of these findings for the development of a community approach to social work and for the degree to which social workers can expect to control their work as autonomous professionals.

New restrictions on the payment of income support and housing benefit to young people are likely to affect their ability to leave the family home. Yet little is known about the sorts of young people who leave home and the likely effects of the changes. This paper uses nationally representative data to look at the characteristics of Scottish teenagers who have left home, the reasons they gave for leaving home and the sorts of problems they faced on leaving. We also examine the labour market experiences of teenage leavers, and compare their experiences with young people who remained in the family home.

This essay presents the Danish Act of 1891 on old age relief as an alternative to the German social insurance approach and as a precursor to the British Act of 1908. The hypothesis is that a form of welfare provision for the elderly developed in Denmark under agricultural rather than the industrial conditions which conventional thinking usually assumes necessary for such welfare developments. The influence of the Danish scheme upon the debate in Britain is documented and discussed.

The determinants of the number of children in local authority care in England are examined using methods that distinguish the implications of current flows into and out of care from the continuing impact of past decisions. In the long term, the decline in the admission rate and the time that children can expect to spend in care between 1977 and 1986 would produce a 39 per cent fall in the number of children in care from that implied by flows into and out of care in 1977–8. These changes have been compounded by an 11 per cent decline in the size of the child population. In fact, though, the higher level of admissions in the past means that the number in care fell by only 29 per cent during this period. If admissions and rates of leaving care have remained at their 1985–6 levels since then, the number of children in care will drop by around 8,300 to under 59,000 in 1991.