Essays on the Welfare State

Titmuss, Richard, Richard M Titmuss

• Publisher: Policy Press
• Year: 2018
• Print ISBN: 9781447349518
• eBook ISBN: 9781447349556
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

Richard Titmuss (1907-1973) was a pioneer in the field of social administration (now social policy) and this reissued classic contains a selection of his most famous writing on social issues. It covers subjects ranging from the position of women in society, changes in family life, and the social effects of industrialisation, to the problems of an ageing population, pensions, social security and taxation policy, and the development of the national health service. This collection contains one of Titmuss's most original contributions to the analysis of welfare policy – his reflections on 'The social division of welfare'. The book stands the test of time as representative of his thinking, and as an inspiration to those who wrestle with the complex issues of our welfare state.

1

Social Administration in a Changing Society1

The decision of the University of London to create a new chair in Social Administration was an expression, I suppose, of the importance of the social services today in the life of the community. It was also perhaps a sign that, in the eyes of the University authorities, the subject had advanced to a respectable age and had acquired some academically respectable disciples; that it had grown out of its former preoccupation with good works for the deserving poor; and that the subject now justified an academic chair, and someone to invade, on the one side, a modest corner of the territory of public administration and, on the other, some part of the broad acres of sociology.

It might be said, then, that the days when social administration, with its interest in the education of future social workers, was regarded in University circles as a poor but virtuous relation, are now coming to an end. It is an interesting speculation, but hardly justified, I think, by the arrival of a new professor. ‘Promise,’ as George Eliot remarked in Middlemarch, ‘was a pretty maid, but being poor she died unwed.’

The future of social administration depends, to some extent, on the future of the great experiments in social service which have been launched in Britain in recent years. Their future is uncertain. To this uncertainty must be added, in the teaching of social administration, the awareness of intellectual uncertainty which attends on those concerned with the study of human relations, for only now are we beginning to grope our way towards some scientific understanding of society. Uncertainty, then, is part of the price that has to be paid for being interested in the many-sidedness of human needs and behaviour. However, we draw some comfort from Karl Mannheim’s thought2 that it is precisely our uncertainty which brings us closer to reality than is possible for those who have faith in the absolute or faith, I would add, in the pursuit of specialization.

It is customary on these occasions to begin with a broad definition of one’s subject. After these preliminaries, I propose to say something about the origins of the Social Science Department. Next, I shall briefly discuss certain aspects of the historical development of the social services since the beginning of the century, and I shall attempt to explain how these developments have contributed to some of our present difficulties. Then I shall try to formulate certain problems of social, economic and administrative importance which seem to me to require more study. Finally, I shall attempt a few generalizations about the nature of some elements of social change which, by their effect on the individual and the family, affect also the structure and roles of the social services.

Social administration may broadly be defined as the study of the social services whose object, to adapt Simey’s phrase, is the improvement of the conditions of life of the individual in the setting of family and group relations.3 It is concerned with the historical development of these services, both statutory and voluntary, with the moral values implicit in social action, with the roles and functions of the services, with their economic aspects, and with the part they play in meeting certain needs in the social process. On the one hand, then, we are interested in the machinery of administration, which organizes and dispenses various forms of social assistance; on the other, in the lives, the needs, and the mutual relations of those members of the community for whom the services are provided by reason of their belonging to that community. To take part in the study and teaching of these subjects in the spiritual home of Sidney and Beatrice Webb is a privilege. For this and other reasons I am deeply conscious of the honour of being the first occupant of this chair, not only because it is a new one, but because it carries with it the headship of the Department of Social Science and Administration. The department has for long been associated with many distinguished men and women. Nearly forty years ago, Professor Tawney was in at the start of the department. Academically speaking, it was not perhaps a very respectable affair in those days. That it is more acceptable now is due to Professor Tawney and to many men and women who, like him, never ceased to demonstrate their belief in the possibility of social progress. Thus, it is not chance that brings me here tonight but faith, the substance of things hoped for by my predecessors, ‘the evidence of things not seen’.

In December 1912, on a proposition by Mr Martin White, seconded by Mr Sidney Webb, it was decided to establish a Department of Social Science as part of the School of Economics to continue, according to the minutes, ‘the work so admirably carried on since 1903 under Mr C. S. Loch of the Charity Organization Society’.4 The new department was helped by financial aid from Mr Ratan Tata, an Indian millionaire, who promoted the Ratan Tata Foundation, whose main function, under the directorship of Professor Tawney, was to inquire into the causes of poverty. The Foundation was linked to the new department, which was then known as the Ratan Tata Department of Social Science. It was not until 1919 that the School assumed complete responsibility.

At the start, in 1913, there was a straightforward bluntness about the teaching purposes of the department. ‘It is intended,’ states the Calendar for that year, ‘for those who wish to prepare themselves to engage in the many forms of social and charitable effort.’ A one-year course of theory and practical work was provided, and the students were examined for the award of a certificate. Some of the questions set in the first examination bear a strong resemblance to those which The Economist asks of its readers from time to time. ‘How far,’ ran one question, ‘is the danger of demoralizing the hardworking classes by over-legislation a real one?’ And just as pertinent was the question — ‘To what extent are we justified in regarding the theories of the earlier economists as the outcome of the social needs of their day?’ A value-judgment, as we should call it now, seems to have slipped into this question which suggests that later economists were more objective in the formulation of their theories.

It may seem to some of us today, conscious of the need for a better understanding of motive in human behaviour, of the dynamic relationship between man and society, that the educational problems facing the new department were relatively simple. It was still possible to accept the surface view of reality in behaviour, for awareness of the new layers of the human mind opened up by Freud’s study of the unconscious had not as yet penetrated very far. The anthropologists had not yet begun to stress the importance of the configuration of culture, economics could still be unashamedly taught to social work students without much reference to theory, while statistics in the hands of Mr Bowley (as he then was) were, by all accounts, a pleasurable experience. The staff of the department, like the syllabus, was more manageable than it is today. Professor Urwick, who was in charge, was assisted by Mrs Bosanquet and by visiting lecturers. Under the heading of ‘Economics’ a course of lectures was given by one practical-minded visitor on The Household Economics of the Handworking Poor’. For the sum of 10s. 6d. the students were told in six lectures how the poor bought their food, stored it and cooked it. Karl Pearson came and discussed the merits and demerits of breast-feeding and the relationship of alcoholism to infant mortality. Early in 1913 a new staff appointment was made, and judging by the book on social work which the new assistant subsequently wrote,5 he seems to have been a good choice. There were only two applicants for the post and, according to the minutes, the selection committee, ‘after very careful consideration’, appointed Mr C. R. Attlee. Unfortunately, the minutes are silent about the committee’s opinion of the rejected candidate. He was Mr Hugh Dalton.

Throughout the years of change and expansion that followed, the department established a reputation for flexibility in teaching, for friendliness in relations, and for the interest it took in the welfare of its students that was largely due to the influence of five people: to Urwick, for his pioneering work as head of the London School of Sociology from 1903 to 1912 and from then until 1921 as head of the Social Science Department; to Hobhouse, for his faith in social progress based on his concept of the ‘liberation of the individual’6 and for his personal interest in the studies of each student to whom he was known, I am told, as ‘Father Christmas’; to the stimulating personality of C. M. Lloyd who succeeded Hobhouse in 1922; to my predecessor, Professor Marshall, who took over the department during a difficult period of reconstruction at the end of the Second World War and, lastly, to the wisdom and devotion of Miss Eckhard who has played such a large part in steering the fortunes of the department and its many students since she first joined the School in 1919.

This department for the study of social administration was founded at a time when fundamental moral and social issues were being debated with vigour and a new sense of purpose. It was a product of the ferment of inquiry to which the Webbs, Charles Booth and many others contributed so much. Poverty, on the one hand, and moral condemnation of the poor on the other, were being questioned. Inquiry was moving from the question ‘who are the poor?’ to the question ‘why are they poor?’ Professor Tawney, aware, as he has repeatedly taught us, that the most important thing about a man is what he takes for granted, was in his element when he gave his inaugural lecture as Director of the Ratan Tata Foundation before the new social science students. The problem of poverty, he said, is not a problem of individual character and its waywardness, but a problem of economic and industrial organization. It had to be studied first at its sources, and only secondly in its manifestations.7

This warning was timely, because it was a period when social policies were being shaped by diagnoses which took account of the presenting symptoms rather than of the causes of contemporary social ills. The great collectivist advances at the beginning of the century, with their positive achievements in social legislation, were aimed at the gradual overthrow of the poor law. But because there were no alternative ideas to work with, no new insights into the social phenomena of human needs and behaviour, the ideas and methods of the poor law were transplanted to the new social services. Many of the services which were born in this period — perhaps the most formative period in the evolution of the British social services — had their character moulded by the moral assumptions of the nineteenth century. This antithesis of social purpose and administrative policy had, as I shall attempt to describe, far-reaching effects on the structure and functions of the new services.

The poor law, with its quasi-disciplinary functions, rested on assumptions about how people ought to behave. It only went into action if people behaved in a certain way and the services it provided were based on conditions that people should thereafter behave in a certain way. Such principles of retribution, when applied to problems of poverty and ill-health, played an important role in settling the structure and the methods of administration of the new services. If poverty was a mark of waywardness then the poor needed moral condemnation or rewarding; as the Old Age Pensions Act of 1908 set out to apply in separating the worthy from the unworthy poor by withholding pensions from those ‘who had habitually failed to work according to ability and need and those who had failed to save money regularly’. If poverty was a matter of ignorance then it was the moral duty of one class in society to teach another class how to live, and to lead them, through sanitation, soap and thrift to a better station in life, described by Stephen Reynolds as ‘the spiritual squalor of the lower-middle classes’.8 If ill-health was a matter of individual error then, as the Webbs put it, there could not be free choice of doctor among the poor for such freedom would encourage the prevailing passion for bottles of medicine, and would not lead (I quote from the Webbs’ book The State and the Doctor) ‘to stern advice from the doctor about habits of life on which recovery really depends — to look to him to speak plainly about the excessive drinking or the unwise eating which cause two-thirds of the ill-health of the poor’.9

These valuations about the nature of man were written into the social legislation of the day. They informed the means of policy. Derived, as they commonly were, from the norms of behaviour expected by one class from another, and founded on outer rather than inner observation — on abstract ‘knowledge about’ rather than concrete ‘acquaintance with’ (to use William James’s words) — their application to social questions led the new services to treat manifestations of disorder in the individual rather than the underlying causes in the family or social group. Thus, there was no attempt to look closely at the mainsprings of behaviour; to ask why great quantities of medicine were consumed at the time; why one-third of the national population of old people aged seventy and over were on poor relief;10 why family life had so changed that families would not, it was said, accept responsibility for aged parents and why there was, according to Masterman, so much talk of a weakening in the willingness to work.11 These valuations of Edwardian days have a curiously topical ring about them.

The inner realities of behaviour were largely ignored in this formative period of the social services and many started their careers dressed with assumptions about how people ought to behave. Insight was lacking, partly because the means of acquiring it were not yet to hand, and partly because the structure of society then did not encourage those who influenced social policy to understand the lives of those for whom the services were intended. Need and behaviour were still conceived of in terms of the individual rather than the family or the work-group. The abstractions of economic thought lingering on from the nineteenth century were wrapped round the concept of individual man acting outside the matrix of his particular society. Some philosophers continued to affirm that man alone was responsible for his sins and his suffering. Administrators and industrialists still tried to ignore, against the rapidly advancing ideas of mutual aid, the social relationships of the worker. Metaphysical individualism of the nineteenth century still exerted some effect, as Dewey has observed, by keeping the system of values in subjection to unexamined traditions, conventions and institutionalized customs.12

The social services of the early years of the twentieth century cannot be understood apart from the particular culture in which they grew up. Many have survived to this day with few modifications in structure. The extent to which poor law ideas were carried into the new legislation which sought to destroy the poor law, and the tensions that result from the clash between social changes and institutional rigidities have presented, and continue to present, some difficult problems. One or two examples may add concreteness to these generalizations.

When, in 1911, National Health Insurance provided a cash payment for periods of sickness a single man received the same as a man with a wife and several children to support. Nearly forty years passed before the State gave partial recognition to the existence of the wives and children of sick workers. The concept of insurance, in which individual premiums relate to individual risks, may have been more applicable under the 1911 Act which covered only a section of the population and excluded dependency with its greater variation in risk. Today, the insurance element in health insurance benefits is practically a myth. Nevertheless, we still retain an expensive administrative machine, part of whose functions is to check the premium record before millions of benefit payments are made.13

When medical care by general practitioners was introduced in 1913 for insured workers, a service which Sir James Barr, the President of the British Medical Association, prophesied would produce ‘a race of gently-reared hot-house plants’,14 the wives and children of these workers were excluded — excluded for thirty-five years. Throughout this period, the profession continued to talk of ‘the family doctor’. Whether this situation of family doctoring has ever had any reality for the mass of the people has not been investigated. For all we know about general practice, the family doctor may be a projection of middle-class norms of behaviour.

The way in which these and other institutions took structure and form, and the extent to which they detached the needs of the individual from the needs of the family, partly explain the ad hoc and fragmentary growth of the British social services. From these beginnings the new services were developed, in no coherent order, to cater for certain categories of individual need; for certain categories of disease and incapacity, and for certain special needs of special groups. Classes of persons in need and categories of disease were treated; not families and social groups in distress.

During the ensuing thirty years we went on breaking off more fragments of need from the poor law, from the general body of medicine and from the scattered activities of voluntary organizations. As the accepted area of social obligation widened, as injustice became less tolerable, new services were separately organized around an individual need. Through all these complications of social service imposed on an unreformed local government structure there was drawn a tangle of administrative rule and regulation; a frightening complexity of eligibility and benefit according to individual circumstances, local boundaries, degrees of need and so forth. The complications of social provisions and administrative structure — the fixed person for the fixed duty in a fixed situation — helped to call into being a variety of social workers and professional groups part of whose functions, narrowly conceived, was to translate the complications for the ordinary man and to match a variety of individual aids to a family in need.

How all this came to pass, untidily human and perversely shaped as it was, can be learnt only by understanding the history of the social services since the great surge forward in legislation for collective help during the decade before the First World War. The benefits and stimulus of combination — of mutual aid — among the workers joined with the passionate effort of social reformers drawn from all classes in society to achieve, first an advance here and then there. The advances that were made represented an accumulation of political and social compromise; each perhaps constituting, in the circ...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Introduction
• Preface
• 1. Social Administration in a Changing Society
• 2. The Social Division of Welfare: Some Reflections on the Search for Equity
• 3. Pension Systems and Population Change
• 4. War and Social Policy
• 5. The Position of Women: Some vital statistics
• 6. Industrialization and The Family
• 7. The Hospital and Its Patients
• 8. The National Health Service in England: Some aspects of structure
• 9. The National Health Service In England: Some facts about general practice
• 10. The National Health Service in England: Science and the sociology of medical care
• Appendix to lectures on the National Health Service in England: Summary of Evidence and Sources of Reference on the Quantity and Quality of the General Practitioner’s Work
• Notes
• References