Abstract
Roy Parker, who died in January 2017, was one of the first researchers to study foster care and adoption and was Chair of the British Association for Adoption and Fostering (BAAF – now CoramBAAF) for six years from 1980. One of his last projects was a historical review of the concept of severe and multiple disadvantage and responses to it. At a time when 13.5 million people, including 30% of the UK’s children, are living in poverty (Joseph Rowntree Foundation, 2016) we publish it to mark his enormous contribution to the welfare of disadvantaged children and families.
Introduction
It is beyond doubt that looked after children are among the most disadvantaged groups in the country. Their childhoods are often marked by family breakdown, neglect, abuse and difficult behaviour, or a combination of all four. Fostering and adoption help address these problems but are only part of a plethora of interventions intended to assist severely disadvantaged people. Policies regarding financial benefits, housing, health and education also affect the children and their families. If we are to understand how these services have developed and why they are like they are, we have to look outside the frame and examine how problems are defined and responses fashioned, and how and why these perceptions change. This article offers such a historical review.
Seen from an historical perspective, various terms have been used to describe the situation of those who have fallen outside the mainstream. There has been, and still is, a profusion of such classifications, classifications that incorporate much popular, professional and official judgement. Although popular usage is slow to evolve, professional and official terms change more often, particularly when those previously used become discredited. That process has reflected shifts in attitudes, in understanding and in what are considered to be the pressing problems of the moment. However, such revisions make it difficult to trace the history of the responses that have been made. In this article we will employ the general term ‘disadvantage’ as it is less pejorative than others, covers many aspects of people’s lives, varies in severity and comprises a mixture of different conditions.
Whatever the language employed, the term remains a simplification but one that serves a purpose; namely, to group together individual variations into manageable categories. That, in its turn, affects the judgements that are made and the manner in which collective responses are arranged. The significance of definitions is amply illustrated in many official and other reports on disadvantaged people, especially those with mental health and ‘mental deficiency’ issues. One typology distinguished between the ‘feebly minded’, the ‘moral defective’ and the ‘psychopath’; another employed a hierarchy that included terms like ‘idiot’, ‘moron’ and ‘imbecile ‘(HMSO, 1957). Typically, quantitative measures (for example, IQ tests and, earlier, the measurement of head sizes) were used to make these assessments, leading to the classifications being one-dimensional, usually medical or psychological. Classifications like these largely determined what services were provided although these offered little variety and were principally institutional.
Thus, the history of how the severely disadvantaged have been treated has been closely associated with definitions. First, because they have been an integral part of how the ‘problem’ has been seen and what ‘solutions’ have been favoured. Secondly, definitions have been important because they have been used to indicate who is to be included in the group so described.
That, of course, has been significant in fixing the size of the ‘problem’. Indeed, there has been a marked tendency to stop definitions becoming too wide so that the ‘problem’ could be kept within politically and financially acceptable limits. As a result, those to whom the designation has been applied have been regarded as being distinctly different from other people and liable to be considered unworthy, undeserving or victims of their own shortcomings. Nevertheless, questions about how they should be treated have a long history: punishment versus compassion, treatment versus training, exclusion versus inclusion, eligibility versus ineligibility, and so on.
Clearly there has never been just one multiply and severely disadvantaged group and different agencies have concentrated upon different categories. Indeed, it has been unusual for the extent of multiplicity to be acknowledged in what has been done. Typically, services have been preoccupied with single problems. Likewise, national policies (where they existed) have concentrated upon certain issues to the exclusion of others, partly influenced by the public clamour of the moment.
Some of these issues will be pursued further in the context of their historical significance, but first we should draw attention to certain features of the concept and reality of severe and multiple disadvantage.
Important features of severe disadvantage
The effect of combination and accumulation
If a disadvantage is severe it is generally multiple. If it is multiple it is generally severe. However, there are complicated ways in which severity and multiplicity combine. For example, when less serious problems accumulate they may well constitute a severe disadvantage. Indeed, research by Rutter and colleagues (Rutter, 1979) on the mental health of young people has shown that each additional disadvantage compounds the severity of the overall problem and that it does so exponentially. Similarly, Gordon and colleagues’ (Gordon, Parker and Loughran, 2000) survey of disabled children in Britain illustrates how one serious condition is usually combined with other disabilities and that the more severe it is, the greater the number of additional problems and vice versa.
Hence, the question of how different disadvantages accumulate is crucially important, both for understanding how situations worsen and how they get better. Does the process of accumulation differ depending upon individual situations, upon ‘precipitating’ factors or upon how long this or that disadvantage has been borne? It has been commonly assumed that certain disadvantages or conditions inevitably lead to others: drunkenness, idleness, delinquency, chronic ill-health, family break-up, homelessness, persistent unemployment, drugs, vagrancy, and so on. For example, Rowntree and Sherwell, writing in 1899, gave pride of place to the heavy and rising consumption of alcohol. In the 1960s the ravages of homelessness received much publicity, not least as a result of the film Cathy Come Home, which portrayed how being without adequate material facilities – shelter, privacy, belongings and often food and money – leads to a dearth of psychological relationships, a state of anomie, rootlessness and not belonging anywhere.
Considerable attention, both professional and administrative, has been devoted to the determination of severity, not least in the debates about who should be reckoned to be poor (in the 19th century more often who was actually destitute). Likewise, the assessment of degrees of physical and mental disability has played a central part in ascertaining eligibility for certain benefits (and at what level) as well as being linked with decisions about treatment. The history of war pensions provides a telling example, their level being fixed in 20% bands depending upon the assessed degree of disability that wounds and trauma have created (Ministry of Pensions, 1949).
Although the assessment of degrees of severity has been a prominent feature of the welfare and medical systems, its multiple character has tended to be overlooked. Yet, if anything, it is a more complicated concept (and reality) than severity. If that were better appreciated, the amelioration of disadvantage might be able to be more effectively organised. How, for example, are the different elements in multiple disadvantage related? Some are causally linked, as when deafness produces social isolation. Others may follow in sequence or interact in ways that bring certain conditions into prominence, as in degenerative illness or when those suffering disadvantage are thrown together by force of circumstances.
Indeed, disadvantage (whether severe or not) can have a ‘ripple’ effect, one person’s disadvantage being liable to create disadvantage for the people with whom they are closely associated. Studies of informal kinship care show that those who do the caring (principally women) can be disadvantaged in the process, especially when they are already poor, disabled, sick or grappling with the problem of caring for (and about) more than one person (Selwyn, et al., 2013). In the contexts of the family or community, such clustering of disadvantages has been more readily recognised in regard to the family and community than it has in the case of the single individual.
Although concern about the ‘spread’ of disadvantage has been prominent in the history of public health (Smith, 1979), it has also been significant in other welfare systems; for example, in the way in which the poor law endeavoured to prevent one generation of paupers producing the next (Crowther, 1981; Webb and Webb, 1910; 1927) and, more recently, in attempts to combat what was termed the ‘cycle of deprivation’ (Rutter and Madge, 1976), which in its various manifestations has a long and chequered history – witness the eugenics movement, which attracted prominent supporters well into the late 1930s (HMSO, 1933; Searle, 1976; 1990). Indeed, a good deal of disadvantage has been attributed to inter-generational continuities, much of it (such as congenital syphilis) being seen as the shortcomings of parents being transferred to their offspring (HMSO, 1916).
The dynamics of disadvantage
Disadvantage is rarely static. In most cases there are several stages in its development: for instance, onset, progression, response to interventions and treatment and (one hopes) escape. Some disadvantages are permanent, others episodic or transitory and each has the possibility of getting worse or better. These are all important distinctions. The situation of young people who have begun life with a grave disadvantage, such as deafness or brain damage, is different from that of those whose disadvantages have occurred later in life, such as progressive hearing loss or the harms inflicted by severe addictions. In these latter cases there will have been a history of living without those particular burdens, a matter that might be important in the kinds of help provided.
Various disadvantages can be reduced or eliminated by technical changes, such as digital hearing aids, power chairs, new drugs or the provision of prosthetic limbs. However, some severe disadvantages are associated with a lack of confidence or poor self-image and these aspects of multiplicity may be able to be addressed without great cost or resort to high technology; for instance, by orthodontic treatment, speech therapy, skills training or literacy programmes. Even though many of the severest disadvantages facing young people will not be quickly lessened by such measures, progress may depend upon the engineering of numerous small improvements rather than the pursuit of grand solutions. After all, much severe and multiple disadvantage has been created by the downward succession of just such increments, so perhaps an upwards progression (rather in the way that much advantage is created) can be achieved by equally modest steps.
Perceptions of multiple and severe disadvantage
Although there are recognisable patterns of multiple and severe disadvantage, there are also wide variations. Likewise, there are considerable variations in public attitudes towards those who suffer disadvantage, attitudes that are shaped by many factors. Three in particular are noteworthy: age, gender and the nature of the dominant disadvantage.
Historically and culturally the designations child, young person and adult have had no fixed ages attached to them and for legal and administrative purposes almost all ages up to and including 21 (and in some instances beyond) have been, or are, employed in the UK to differentiate status, rights and responsibilities (Parker, 2004). Hence, the choice of a particular age group can raise certain problems, particularly from an historical perspective. Take, for example, the category 16–21 years old. It spans many administrative boundaries between child and adult services, boundaries that have long created difficulties in ensuring the continuity and co-ordination of services; for example, upon being discharged from care at 18, being transferred from child to adult mental health services, having different housing rights, leaving school, and so on. Thus, not being quite the right age to receive this or that service or financial benefit might itself become an added disadvantage. Conversely, certain ‘welfare advantages’ may come with getting older.
Indeed, much of the ‘welfare system’ is, and has been, constructed around an array of age categories that have reflected a mixture of political and economic considerations as well as public attitudes to the rights and responsibilities of people of different ages. Those who continue to be regarded as children (whether children or not) usually evoke sympathy. Generally, however, as age increases, less is likely to be excused and more expected, although these gradations have not always been the same, for example, the age of criminal responsibility, the age of majority (and minority, of course) and the age at which this or that employment has been prohibited. In our culture the ‘transition zones’ between childhood and adulthood have been (and remain) imprecisely defined.
Not only have public attitudes towards those who suffer severe and multiple disadvantages been influenced by their age but also by their gender. Men and women tend to be exposed to different combinations of disadvantage. For women these have often been associated with sexual exploitation and with unmarried motherhood, both of which have been variously attributed to moral laxity, to wanton behaviour and low intelligence (HMSO, 1974). Such opprobrium has constituted an additional disadvantage, not least when it has existed in conjunction with the services offered. Furthermore, in the past many of these services were provided by religious bodies that emphasised the need for moral reform (Young and Ashton, 1956).
Attitudes to disadvantaged men have had more to do with their participation in the labour market. Being unemployed without apparent good cause was considered to show that they were workshy, layabouts, idle, wastrels or scroungers. Indeed, a major part of the poor law system was constructed in order to deter the ‘able-bodied’ (principally men) from seeking (and obtaining) financial relief. Hence, the workhouse test and its associated principle of ‘less eligibility’, which required that the circumstances of the pauper should never be made better than his employed counterpart. Women without paid employment were not exposed to such severe judgements, reflecting the expectation that it was men who should be the principal breadwinners and that women ought to be occupied with housekeeping, the care of children or only secondary outside work (Hewitt, 1958; Millar and Ridge, 2009). 1
The consequences of severe disadvantage may also be explained differently for men and women. Currently, for example, difficult behaviour among young men is likely to be classed as a conduct disorder whereas, in the case of young women, it tends to be described as an emotional disturbance, both of which interpretations have implications for professional and public responses to what may in fact be the result of a similar combination of disadvantages (Office for National Statistics, 2003).
Age and gender are not the only factors that have influenced how those who bear these burdens are regarded and treated. For example, although most severe disadvantages are multiple, some are more apparent than others and some attract more attention. Attitudes towards disadvantaged people tend to reflect assumptions about the causes of their most prominent disadvantage. Whatever the reality, some disadvantages are assumed to be self-inflicted, and therefore blameworthy, while others are understood to be outside a person’s control and so deserving sympathy rather than condemnation, as in the contrast between the smokers disabled through strokes and those damaged by the consequences of medical errors (such as the use of thalidomide). This is reflected in the public’s favourite charitable donations: medical research, hospitals and hospices, and children and young people (Charities Aid Foundation, 2014). The problem arises in those many cases that lie in the uncertain areas in between, especially where blameless conditions nevertheless result in difficult, challenging, unpredictable or threatening behaviour. Certainly, better understanding has helped, but even then the persistence of such conditions, and indeed their worsening, can exhaust the energy and commitment of those who endeavour to help.
For most helpers (whatever their status) there has to be some kind of reward for such commitment, as there has to be for those to whom help is being offered. We understand rather little about the nature of ‘reward systems’, especially how they survive or crumble over time. A sense of duty, of responsibility, of compassion, of religious mission or simple habit may all play their part. There is a natural tendency to shy away from acknowledging the arithmetic of giving and receiving, although it constitutes an important element in helping relationships, the survival of which depends on the existence of a measure of reciprocity (Blau, 1964). Not being able to reciprocate, or not feeling capable of doing so, can become yet one more (potentially serious) disadvantage.
Salient features of the historical background
A few cautionary words are necessary before outlining some of the main features of the way in which, in the past, people suffering severe and multiple disadvantages have been regarded. The importance of age and the fact that services for children cannot be separated from those for adults have already been discussed. 2
A further caution concerns the interpretation of disadvantage, particularly when it is severe. Given that the concept of disadvantage is relative (that is, the ‘absence of advantage’), its historical distribution has influenced how it has been viewed. Mass poverty, mass unemployment, mass illness or mass despair have a different impact on the politics of welfare than pockets of disadvantage. When most do not suffer from gross disadvantages, the disadvantages of those who do are more likely to be classed as severe. What are regarded as severe disadvantages at one time or place are not necessarily the same as those at other times or places, a reality vividly illustrated today in the narratives of children living in war zones (London, 2007). Indeed, some of the most severe disadvantages have been created by political, religious and racial persecution, or a combination of all three.
One final point to be borne in mind is that the term disadvantage is rarely to be found in conjunction with the provision of a personal service, principally because it was not easily quantifiable. Instead, we find more reference to destitution, to handicap and to disability.
Having re-emphasised these qualifications, five features of past services for the ‘disadvantaged’ are especially noteworthy:
the early dominance of institutional provision; the fragmentation of personal services; the emergence of community care in the early 1960s; the contribution of the services that have been universally available; and the rise of social markets.
1. The dominance of the institution
Institutions have figured prominently in the history of disadvantage. In the first place they were a favoured way of dealing with those who were judged to be destitute, mad or bad for whom there was the workhouse, the lunatic asylum or the prison. Walls provided the means of exercising control over troublesome behaviour, a control that was necessary if such behaviour were to be altered and improved. This might be achieved by systems of coercion but quite as readily by training and treatment. It was assumed that none of this could be ensured by occasional contact in unregulated situations (Skull, 1979).
However, admission to an institution carried the likelihood that it would add yet one more disadvantage. Because admission was often a matter of last resort and a mark of social failure, it was a stigmatising process. Such initial stigma was accentuated in at least two other ways. One was by association and the other through compulsion (Goffman, 1963).
Despite the desire of many administrators to separate the ‘deserving’ from the ‘undeserving’ and the ‘reputable’ from the ‘disreputable’, the reality of institutional life has been one of enforced and uncertain association. The choice of associates is limited and escape from the disruptive, distressing or frightening behaviour of other people well-nigh impossible. When people living in institutions are regarded in an unfavourable light, those who are obliged to join them are likely to be seen in the same way, irrespective of the reasons for their admission.
The negative image of institutions has been reinforced by the legal compulsion that has preceded much admission. Until 1930, for example, the doors of public institutions for the treatment of the mentally disordered were closed to all but people certified by a judicial authority as ‘a lunatic, an idiot or a person of unsound mind’ and ordered to be detained. Not only was admission dependent upon certification but the order for commitment carried with it the prospect of its irrevocability. Furthermore, the same system of certification was applied to the mentally ‘handicapped’ as it was to the mentally ill. Indeed, the lack of understanding about the differences between these two conditions was superimposed upon the popular assumption that mental afflictions were hereditary. This meant that the act of certification was often experienced as a matter of family shame. Even though after 1930 it was possible for patients to enter a mental hospital on a voluntary basis, this relaxation did not apply to the ‘mentally defective’ until the reforms introduced by the Mental Health Act of 1959.
Institutional regimes did not affect only those who were admitted. In many cases they were also intended to convey a deterrent message to the far greater number who were assumed to threaten to overwhelm the available resources or to disturb a precarious social order. The discipline of the institution had wider implications.
The history of hospitals is interesting on this point. Before the latter part of the 19th century, most illness was endured at home and sick people only entered hospitals if they were destitute, homeless or lacked anyone to look after them. However, once started, the late Victorian expansion of hospitals proceeded apace with the number of beds in voluntary institutions rising from 15,000 to 57,000 between 1861 and 1921 and separate services emerging within the poor law, the infirmaries and the local authorities, which began to build ‘fever’ hospitals for infectious diseases. The character and public image of hospitals were changing, improved by advances in medicine, the ambitions of the medical profession and the professionalisation of nursing, showing again that both the classification of people’s conditions and the designation of the services to which they are referred have been important in determining the acceptability of that service, as well as the support that it is likely to enjoy.
2. The fragmentation of services
As the ‘severely and multiply disadvantaged’ are such a heterogeneous group, it is not surprising that the services that have been available to them have been fragmentary. There are, however, other factors that have accounted for such fragmentation. Three in particular are notable: decentralisation, voluntary and charitable involvement, and professional developments.
Although the poor law system existed throughout the UK from the 17th century up to the Second World War, boards of guardians exercised considerable discretion as to how that system was administered (Digby, 1978). Each board set its own poor rate (the local tax), decided matters of eligibility for assistance and appointed its own staff. Indeed, the amount of local variation was further increased because those staff (such as relieving officers) could be given, or assume, a further degree of discretion. Hence, despite the efforts of central government inspectors to secure more uniformity in its administration, there was considerable variation in what help the severely and multiply disadvantaged might receive from the poor law in different parts of the country, not least as between England and Scotland and urban and rural areas (Murphy, 1992). Furthermore, it has to be remembered that boards of guardians were elected (albeit initially on a limited suffrage) and that decisions were taken by majority voting. In this, the convictions, prejudices, sympathies and local experience of the members played their part, although from the latter part of the 19th century the patterns of influence began to shift as a result of the election of more women and of others, including women, with socialist affiliations (Hollis, 1987; Prochaska, 1980).
Nevertheless, few of the services that were available from the poor law (and from its successor, the local public assistance committees) were what, today, we would regard as personal services. These were more often provided by voluntary organisations: training for the blind or deaf, aid for the crippled, employment for disabled ex-servicemen, support for unmarried mothers, sponsored emigration, and so the list could be added to. Although varied, such initiatives had four characteristics in common: many relied upon institutional care, little co-ordination existed (in fact, there was a good deal of competition for public support and therefore for funds), their financial states were often precarious and most concentrated their efforts on single, clearly identifiable conditions. Many initiatives were local and often short-lived. Furthermore, there was no notion of a generalised ‘disadvantage’ that influenced the way in which such services were organised. All this added further to the picture of fragmentation and uncertainty – uncertainty about what might be available to whom, when, where and on what terms.
The third reason for the fragmentary nature of the personal services available to the disadvantaged has been the increasing specialisation within the professions involved. This has been especially marked in medicine but also in the development of social work that grew to include welfare officers, psychiatric social workers, probation officers, medical social workers (formerly almoners), court welfare officers, family welfare staff, moral welfare workers and several other branches (Seed, 1973).
3. The emergence of ‘community care’
Although the emergence of community care as a national policy dates from the early 1960s, the idea that help should be directed to areas of marked disadvantage has had a longer, albeit modest history. From the 1880s onwards these were the places of greatest poverty, disease and overcrowding. Improved housing was the obvious remedy, but little was done until the major slum clearance drive that began in the mid-1950s (Donnison, 1967). What was achieved was mostly the result of action taken by some of the largest urban local authorities and by some philanthropic organisations such as the Peabody Trust and settlement movement (Briggs and Macartney, 1984; Tarn, 1973). The identification of certain areas as a means of tackling disadvantage continued off and on into the 20th century but mostly as government inspired initiatives. For example, there have been community development areas (Department of Economic Affairs and HM Treasury, 1967a), educational priority areas (Department of Education and the Social Science Research Council, 1972) and housing action areas (most of which disappointed expectations).
By the mid-1950s another version of community care was afoot, namely, care in the community. This built on the embryonic system, introduced in 1948, whereby local authorities were given responsibility for providing ‘community welfare services’ but these were unevenly developed and focused mainly on the elderly and a number of other people with specific disabilities. If they were to be assisted, the ‘disadvantaged’ needed to fall into an identifiable category.
The new initiative was driven forward by two main considerations. The first was the quest to reduce reliance on institutional care, especially in the fields of mental ‘deficiency’ and mental illness. The buildings (still popularly known as asylums) were old and no longer met certain minimum standards, many having been neglected during the war years and the ensuing decade. Maintenance costs were high. Staff salaries were rising as better qualifications were sought and unionisation became more common, producing an economic imperative to find an alternative.
A second factor that encouraged the development of care in the community was a growing recognition of the psychological damage caused by long periods spent in institutions, especially for young children, a damage that came to be attributed to ‘institutional neurosis’ (Barton, 1959; Parker, 1988). This, and other shortcomings of the ‘institutional solution’, led to the government requiring local health and welfare authorities to prepare and submit plans for the ‘development of community care’ over the ten years from 1962 (HMSO, 1963a). Some of these plans were ambitious, but most erred on the side of caution, not wishing to provide any hostages to fortune by discharging vulnerable or dangerous people to the outside world
Up until the promotion of community care policy in the 1960s, various comparable services were provided by voluntary bodies, many of them locally based. In 1965 Margot Jefferys (1965) published her study of social welfare services in one large county. Among the voluntary social welfare activities, she listed moral welfare work, the National Society for the Prevention of Cruelty to Children (NSPCC), the missioner for the deaf, an old people’s welfare service, the Citizens Advice Bureau (CAB), a worker from the National Spastics Society and at least half a dozen other agencies. However, all were concerned with particular classes of need. It is also important to emphasise that at this time, most care and assistance were provided by families with little recourse to organised services, whether public, voluntary or commercial.
Although progress was made, it fell short of the aspirations that had been expressed. There were several reasons, some of which still apply. First, the scale of what was needed was underestimated. Once more services became available, increased demand followed. The new social services departments became exposed to pressing demands connected with concern about child abuse on one hand and a growing elderly population on the other, with young adults tending to miss out. A second reason lay in the latitude accorded to local authorities to decide upon the balance of their expenditures. There was no ring-fencing of monies for specific community services, although there were some exceptions later.
The third reason lies in the state of the economy and the pressures on local authorities to reduce expenditures. There was an increase of central government funds to support the development of the personal social services in the first years of the 1970s, but this soon ended with the oil crisis later that decade. Prime candidates for cuts were grants to voluntary bodies and ‘fringe’ services that assisted minority but substantially disadvantaged individuals and families.
4. Universal services
It is tempting to think about the services required to combat severe disadvantage in terms of specific individuals or groups. However, looked at historically, it has been the development of universal services that has reduced the extent of severe disadvantage; in particular, public health measures from the latter part of the 19th century onwards, improved nutritional standards from the early decades of the 20th century, compulsory education and, not least, the emergence of the ‘welfare state’ during and after the Second World War. It is worth recalling the five ‘giant evils’ that were depicted in the Beveridge Report (HMSO, 1942). These were: squalor, ignorance, want, idleness and disease. All were tackled to a greater or lesser degree in the cascade of social legislation that followed. The poor law was dismantled, a national health service established, a social security system put in place and an educational programme launched; efforts were made to deal with the poor housing stock and commitments made to a policy of ‘full employment’ embraced. Although progress was and has been uneven, the coming of the war and the welfare state led to a major onslaught on disadvantage, and particularly on multiple disadvantage, and a more equal society. This contribution should not be underestimated. Indeed, the success of specific schemes to aid particular groups has depended, in part, upon such ‘services for all’ and ‘of right’. As is evident from the impact of today’s government austerity measures, the erosion of such services has had and will have a knock-on effect upon the scale of disadvantage and ability of individualised personal services to achieve what is needed.
5. The social market
One of the most dramatic developments in social policy in the last two decades or so has been the delegation of previously publicly provided social services to the so-called ‘independent sector’. However, this term has (conveniently) conflated outsourcing to private-for-profit enterprises and outsourcing to non-profit voluntary agencies. The distinction is important because these are different systems with different philosophies. Here we concentrate on the former, not least because, unlike in earlier periods, they are in the ascendancy.
The extent and speed of this change is manifest in children’s services where there has been a three-fold increase in the proportion of foster placements provided by independent agencies since the turn of the century when the figure was only 12%. This pattern is repeated for residential care where the increase has been five-fold, with private children’s homes now providing 72% of available places. Similar developments have occurred in education, the penal services, re-employment schemes and, not least, in the health services, and there appears to be little evidence of this transformation abating.
These are profound changes. Some have been beneficial in terms of introducing competition, stimulating new ideas and running better services, especially in places where standards were traditionally low. But disquieting issues of durability, care standards, financial stability, accountability, investment in training and monitoring remain. What is more, the effects on securing the co-ordination of disparate services to promote the welfare of children, the development of national policies, the role of the voluntary sector and the expected cost savings are as yet unknown. Of course, not all these issues are unique to the private sector but they now appear in starker relief.
So, what conclusions can be drawn?
We should be able to ‘learn lessons’ from the past as historical perspective helps us to appreciate the nature of present services and the problems they confront. However, this is easier said than done and it is always possible to draw incorrect conclusions, especially from a brief review such as this. There is also the risk of misinterpreting what has gone before, not least in order to favour those interpretations that confirm what is already believed. We have endeavoured to avoid such pitfalls in suggesting what seem to be some of the more important conclusions that are relevant to improving what is done to better the lot of those children and young people who face severe and multiple disadvantage.
Avoid creating additional disadvantage
Services run the risk of stigmatising their recipients. Whether intended or not, the terms upon which they are provided, as well as the manner in which they are described, can have that effect. One of the reasons for this has sprung from the assumption that a person’s declaration of need confirmed their unworthiness. A second reason derived from the fear that without a measure of deterrence the scale of demand was liable to get out of hand. One further cause of stigmatisation has lain not so much in the deliberate design of a service but in the way in which it has been administered by those dealing with the needful face to face. This has been a particular problem with ill-trained and poorly paid staff but who nevertheless exercised great freedom in the manner in which they interacted with the disadvantaged. There is also, of course, the harm done by untested theories and their associated therapies, some of which have been enthusiastically embraced.
Multiplicity
There has been a long history of the multiplicity of a person’s disadvantages being overlooked or played down. One of the reasons is the difficulty that a ‘system’ experiences in addressing several, often diverse problems in an integrated fashion. Indeed, much organisational reform has sought to diversify functions and responsibilities, often in line with the advance of specialisation in the helping professions. Even when a diagnosis (for want of a better term) has explored and identified the various problems that a person confronts, what is then done has had a tendency to concentrate on single issues, reflecting what help can actually be mobilised. Thus, it is important for second, third or fourth order problems not to be ignored; otherwise they may worsen and accumulate in ways that increase the severity of existing disadvantages.
Chains of events
Much severe disadvantage is the consequence of one disadvantage leading to another. Furthermore, some of these downward increments constitute comparatively small events. Nevertheless, they can have damaging repercussions. We need to know more about such chains of events, how they relate, which (if any) are the prime movers and how far the sequences vary from one person to the next. What are the most important predictors of upward or downward mobility in advantage/disadvantage? Unless we have some reasonably sound understanding of such matters it will be difficult to know how best to mitigate disadvantages, either on an individual or a collective basis.
The balance of advantage and disadvantage
There is a danger that some of the severely disadvantaged people will be seen only in that light. There is a long history of their being disparaged, discounted or blamed. It was often assumed that they could make little or no contribution to their own well-being or to the community more generally. Yet we all experience a mixture of advantages and disadvantages and a mixture that can change over time. Couched in a somewhat different way, the equation might be expressed as a balance of capacities. This shifts the question of what the disadvantaged require to what they are able to contribute.
The importance of visible signs and symbols
Finally, the obvious issue of visibility cannot be ignored. Some features of disadvantage, such as physical disability, are highly visible while others, such as deafness or mental illness, are not. This can lead to misinterpretation when members of the public try to fit what they see into familiar categories. This, in turn, is likely to affect their expressions and displays of sympathy in a way that should not be confused with ill will.
Three further questions
This historical review inevitably raises further questions that help explain the current context of disadvantage. Three are especially significant for children’s services:
Why do public systems consistently overlook high-risk groups? How and why do welfare systems change? Why has the state (both nationally and locally) become the primary provider of welfare services?
1. Who gets overlooked and why?
Before answering the first question, it is important to note that when viewed historically it is not the case that high-risk groups are consistently overlooked, nor is it only public services that bypass them. There is also an underlying assumption that ‘high risk’ and ‘severe disadvantage’ are describing much the same thing, although this may not necessarily be so. With these provisos in mind we suggest that there are a number of interlocking reasons why the needs of the severely disadvantaged fail to be met.
The costs
Helping the severely disadvantaged can be a costly business both financially and socially. It is liable to make high demands on scarce resources not only because of the complexity of the problems to be faced but also because of the likelihood that their amelioration will require long-term commitments. Organisations have limited budgets and are often exposed to contending claims, some of which are orchestrated in compelling ways while others exercise little purchase on the political system. Furthermore, existing divisions of resources are only likely to be modified at the margins. One of the handicaps of the severely disadvantaged is their lack of powerful champions, especially if they fall outside a clearly identifiable group.
As the demands on the health and welfare services exceed their supply, rationing is endemic although its necessity is liable to be denied. One means of rationing is to limit the size of the potential demand, which takes us back to definitions of eligibility. The tighter these are drawn the greater the number of needful people who will be squeezed out. But expected gains may be thwarted as stringent eligibility criteria also have the effect of delaying help until problems worsen, defeating the aim of early prevention.
Discretion
We have already touched upon the impact of discretion in the determination of who gets what, but its significance needs re-emphasising. It is important for two principal reasons. One derives from the fact that most frontline staff are hard pressed. Just as managers and politicians have to decide how to allocate the available resources, so too do field workers whose resources are primarily their time and their energy. Although employees might have a statutory duty to provide help, how they discharge that duty is open to interpretation, as for example in the use of section 20 of the Children Act 1989 to accommodate homeless older teenagers. Even in highly codified organisations such as the social security system, considerable discretion is exercised in the interpretation of regulations and in the manner in which interviews are conducted. Fatigue, exasperation and disapproval all play their part in what can amount to discrimination.
The second reason is that the work can be unrewarding, especially when there seems little prospect of improving matters or when the behaviour of those they seek to help is aggressive, unco-operative or they are believed to be able to help themselves. Naïve optimism is likely to lead to pain and frustration for those involved which, if not dealt with, often leads to an authoritarian approach that is unsympathetic to those who reject seemingly beneficent offerings. Such rejection early in a young person’s life – in education, employment, housing or personal relations – can lead to a severely disadvantaged later life.
Co-ordination
One of the enduring issues in the social services has been their lack of co-ordination. Innumerable committee reports, white papers and circulars have highlighted these shortcomings, castigated the apparently un-cooperative and exhorted them to do better; but little has been done to explain this enduring weakness.
The two most plausible explanations focus on scarcity and domain (Parker, 1969). All organisations have an interest in conserving their resources for fulfilling their primary tasks. Co-operation with another agency is usually seen as a diversion of scarce resources. Hence the quibbles about whose responsibility this or that problem is and who pays. The more bodies that are involved the more complicated the equation becomes, as it does in times of austerity and depleted funds. These arguments about who does what are closely linked to ‘boundaries of responsibility’, hence the fears about the consequences of administrative reform for professional identity and job security.
The consequences of these organisational characteristics are daunting for those whose needs cross boundaries of responsibility. There is the danger of people being passed from one agency to another and in the process failing to have their difficulties properly addressed, engendering frustration, anger, discouragement and a sense of abandonment, further disadvantages in negotiating the complexity of the ‘system’. However, there is sometimes a clear step in the process of status deterioration, such as ‘going to prison’ or ‘entering a home’, and some agencies specialise in helping extreme cases and, sometimes, offer a better service than was available before.
The balance of advantage and disadvantage
If you come from a severely disadvantaged family, live in a severely disadvantaged area or went to a disadvantaged school, you ‘start’ with a burden of disadvantages that then tend to accumulate. If you possess a good stock of advantages, the experience of future disadvantages is likely to be able to be better managed and their ill-effects minimised. One should not discount sheer chance in obtaining an advantage – particularly luck in the person you meet and later becomes your partner, not being born in a country devastated by war or natural disaster, or being born in a country where civic rights are broadly respected, especially the rights of women and children. Unlike the disadvantaged who possess valuable advantages, those who do not are less likely to be able to secure the services they need. Advantage tends to breed advantage, not least in gaining access to help and support.
Rootlessness
Those who are homeless and sleeping rough are clearly among some of the most disadvantaged. Having ‘no fixed abode’ presents many problems, not least the difficulty in gaining easy access to key services. Many crucial documents are based on addresses; for example, the electoral register or certain health records. When they are not readily available to welfare agencies they are liable to cause delay. Furthermore, numerous commercial services (such as banks or insurance companies) require prospective customers to have an address. The lack of an address is a disadvantage that quickly creates others.
Even with an address, geographical mobility can have similar repercussions. Certain groups of the disadvantaged move a lot – to escape debt, violence, unwanted relationships or being found. Some also move in quest of casual seasonal work or cheap accommodation in out-of-season seaside towns. For looked after children, movement is often a common experience. Whatever the reason, highly mobile but disadvantaged people find it hard to establish new contacts with support networks, whether formal services or friends and family. Mutual aid tends to be strongest in immobile communities, even when they are poor. Indeed, non-cash reciprocity depends upon the same people still being around to fulfil the implicit exchange.
So, the answer to the question of why the severely and multiply disadvantaged do not always receive the help they need is complicated, as one would expect with such a disparate group. Although we have highlighted five explanations there are certainly others and, of course, these five factors often overlap and accentuate the problem. If we were to draw one conclusion, however, it would be that some types of disadvantage are more socially approved than others and that those who benefit most are young people who are ‘nice’, ‘deserving’, help themselves and are visible. But numerous poverty and disability studies have revealed that there are also thousands of multiply disadvantaged people and families who are invisible or inadequately assisted.
2. Changing policies, changing systems
A second question that history raises is when, why and how ‘systems’, in this case welfare systems, change. There is a vast literature on this looking at different contexts – social, political and economic – and at various types of change, modifying existing activity, reforming the means but retaining the broad aims and innovation that introduce something radically different (Hall, et al., 1975).
However, these categories are not necessarily associated with particular processes of achieving change. For instance, new legislation can lead to all three types or its intentions being subverted by those who are charged with introducing the new arrangements. Likewise, ministers may drag their feet in issuing a commencement order for legislation already on the Statute Book or the legislation may allow certain things to be done rather than making them mandatory. We should not assume that the outward appearances of change are an accurate reflection of what is actually happening. Indeed, as much can be learnt about the politics of change from what fails to change as from what does. Furthermore, it should not be assumed that all change is progressive; some will be disadvantageous to the cause of ‘welfare’ in general or to particular groups.
Bearing these thoughts in mind, three factors seem to be propitious for effective change: legitimacy, feasibility and support. Legitimacy refers to the extent to which governments and other organisations feel that it is appropriate for them to be concerned with a particular issue and to acknowledge some responsibility for its solution. Feasibility means that a change is judged to be capable of being achieved given the current technology, manpower, knowledge or likely opposition. Support describes the backing necessary in order to see through a change successfully, whether by forming broad alliances, by winning votes, securing financial guarantees or enlisting the help of those with personal or organisational power. Ensuring that these conditions are in place requires diplomatic skills and these, in their turn, rely upon a keen understanding of the relevant political environment. That comes from experience as well as from careful reconnaissance and preparation.
But within a propitious context, other factors are likely to bring an issue into sufficient prominence for it to generate change. We suggest six that are commonly in play.
1. Upheaval and crises
Pride of place in the politics of crisis must go to war. War upsets the established order. Fresh ways of doing things become imperative; new problems demand prompt solutions and weaknesses and shortcomings are exposed. The most obvious example is from the Second World War, during and after which the welfare ‘system’ underwent its most far-reaching shake-up (Bruce, 1961). Both troops and civilians were injured by enemy action and the existing health system was inadequate to deal with these casualties. Free medical care had to be provided, which it was politically impossible not to make universally available or to abandon after 1945. There was no going back to pre-war arrangements.
Similarly, unforeseen reforms followed the Boer War (1899–1902), when the extensive unfitness of recruits raised fears about national security and led to the introduction of free school milk and lunches in the most deprived areas. The 1914–1918 war fuelled reforms in housing as the shortage of accommodation allowed landlords (responsible for 90% of provision) to charge rack rents. Rent control was introduced in 1916 and although intended to be a temporary measure, lasted for nearly 50 years. However, the consequences of wars are not all of one kind; although the Korean War demanded austerity (with prescription charges introduced) and raised demand for health services, it produced low unemployment, so reducing expenditure on benefits.
Wars also increase public sympathy for the ‘no-blame’ victims such as war orphans, widows and bombed-out families, and the establishment of various communal facilities such as civic restaurants. It has also stimulated the development of new technologies and treatments. The ‘shell shock’ phenomenon of the First World War caused an important page to be turned in psychological understanding and theory while recent wars have produced major advancements in trauma treatment and rehabilitation.
Scandals can be another impetus for change. For example, the excessive physical punishment of boys at the Court Lees approved school in 1967 has been credited with the demise of the approved school system but, in fact, it was a death waiting to happen. What it did was to strengthen the hand of the Secretary of State (Roy Jenkins) in his wish to dismantle the system. Similarly, the death of Dennis O’Neill from neglect in foster care in 1945 and the murder of Maria Coldwell, returned to a dangerous family by a court order in 1973, emphasised the need for child protection reforms.
The moral of these examples is that crises and scandals become agents of change when there has been a build-up of previous disquiet and there are influential individuals or prepared organisations (usually pressure groups) ready to seize the opportunity. There are, however, occasions when a particularly shocking scandal makes some kind of government response (whether national or local) unavoidable, usually taking the form of an inquiry and the imposition of more bureaucracy but sometimes something more radical. As investigative journalism and the use of social media have grown, these kinds of pressures on governments have increased.
2. Worrying trends and revelations
When a problem gives evidence of getting worse, particularly at a faster rate than before, governments can be impelled to act. In this, the availability of statistical trend data (and especially extrapolations) has been very important. There are many examples: public expenditure figures, demographic data, crime and children in care statistics, disease patterns, educational performance or unemployment levels. But as governments are keen to keep a tight control on expenditure, new schemes that threaten to be expensive or where the financial implications are uncertain will be more difficult to defend and easier to attack.
Actual or expected changes in the size and structure of the population are another influence upon the ways in which social services have developed, in particular where these have been particularly marked and threaten to increase demands on services. A rising birth rate, a rapidly ageing population or new patterns of migration offer good examples. But forecasting is a difficult and hazardous affair and the point is not whether or not the statistics are correct, although that is important, but whether they are believed to be accurate – and by whom – and whether they are capable of being seriously challenged by alternative figures. It is a well-worn political maxim that if one seeks to effect change then it is important to possess better relevant information than those who oppose you.
3. Association and opportunity
A proposal for change that promises to resolve or ameliorate more than a single problem increases its chances of success. For example, family allowances were only introduced in 1945 (and not before) because by then they were seen as a way of checking a declining birth rate, combating malnutrition among children, maintaining the work incentive, forestalling wage demands and helping to curb inflation rather than as a means of reducing inequalities between rich and poor and between men and women, which had been the aim of their earlier advocates (Land, 1975). One formulation of this process suggested that governments look for an ‘economy of solutions’; for instance, problems that lend themselves to treatment in existing programmes or by existing administrative machinery are likely to make better progress than those that require quite new agencies or ways of working.
There are two senses in which ‘association’ can be important in influencing the fortunes of a proposal or issue and that is the nature of the support it attracts. One is where this is well regarded by a government; eminent backers help, as do associated organisations that wield power and influence and share a current government’s broad philosophy. The other is the convergence of events that present the opportunity for introducing change. Prior to the 1908 Children Act that was heralded as the children’s charter, Herbert Samuel, the Under Secretary of State in the Home Office, said that it was ‘a propitious moment’ for making these important advances. Similarly, prior to the 1989 Children Act, Health Minister David Mellor said that it was ‘an historic moment’ for a major reform of the children’s services. What these kinds of remarks reflect are political judgements that an issue has reached a sufficiently ‘critical mass’ and has gained enough support to elevate its priority.
4. Research: science and technology
We have already noted some of the effects that ‘facts’ can have upon the course of social policy. They serve to demonstrate that a problem exists, its magnitude and its likely consequences. But not all facts make a political impact. They may be repudiated, disputed or ignored. The reception they receive depends upon a least two factors. One is the scientific robustness of the work upon which they are based. Another is the political and economic climate into which they are launched.
The physical and medical sciences are generally regarded as providing evidence of a fairly high level of reliability, although not certainty. Furthermore, the evidence is such that it is not readily susceptible to popular dispute; and there is often confirmatory evidence and the effects are manifest. Technology has made similar but less obvious contributions to social policy; for example, in prosthetics, in house building or controlling air pollution. However, not all breakthroughs in science and technology have had beneficial results. New but flawed high-rise building techniques led to the collapse of Ronan Point 3 and the thalidomide tragedy still blights the lives of those affected.
Nonetheless, matters may be improving. There is much more research available than, say, forty years ago, research, policy and practice are being linked in new ways, there are validated programmes to treat specific conditions and we can now identify the chains of effects that produce severe and multiple disadvantage. We also know more about the nature and extent of social problems, of people’s leisure needs and activities and have far more reliable and extensive statistics about social conditions.
The consequences of this for policy may be different from those for practice. In policy, many other factors confound the influence of evidence. Practice, in contrast, may be more receptive to models offering guidance on what has to be done, but for those working face-to-face with difficult young people, it only goes so far and may offer minimal help in handling fraught situations.
5. Origins
Issues do not arise spontaneously. They are formulated and championed by particular interests. The same applies to the solutions that are proposed. A key question in understanding how things change or remain unchanged is to know where initiatives for change have arisen. There is a big difference between those that originate within governments and those that are pursued ‘outside’, especially when these are critical of the existing state of affairs. However, when a critic’s issue becomes inescapable there is a tendency for it to be annexed by the administration. In 1965, Cole and Utting published a damning report on the economic circumstances of old people and of government policy. The response was for the government to commission its own study, which confirmed the situation (Ministry of Social Security, 1967b). There followed important changes in the pensions system but these were also a result of another convergence: the election of a Labour government in 1964.
Governments can also annex outside but sensitive issues when these are raised through the private members’ bill system. When such bills look like making parliamentary progress they can be taken over by the administration in order to maintain control. That happened with the private member’s clean air bill that Gerald Nabarro introduced in 1954 (Parker, 1975).
Pressure groups of various kinds endeavour to influence the course of policy. Those that are successful tend to be persistent, patient, well-informed, politically skilful, opportunistic and regarded as useful by government. However, most are single issue protagonists struggling to be heard in competition with others. When that issue has little political salience the going is hard but when it has moved up the political agenda their opportunities increase, especially if the proponents of change know more about the matter than government and have developed a reputable expertise.
6. Ideology
Parties in power, whether locally or nationally, subscribe to certain ideologies. The decontrol of rents in 1957 by the Conservative government and the promotion of comprehensive education in the 60s by the Labour administration are good examples of ideologically driven policies.
While a party remains in power, an issue will gain advantage from possessing the appropriate ideological flavour. When political power changes hands, however, these same characteristics are likely to prove a handicap. This poses difficult tactical problems for some pressure groups, particularly those concerned with long-term or permanent issues. Many carefully avoid associating their campaigns with any one party and endeavour to present their aims as non-political and to gather cross-party support. The Howard League for Penal Reform has acted in this way, as have many of the children’s charities. This is easier to do when their concerns are generally viewed as non-political; for example, child welfare, the claims of wounded ex-servicemen, the elderly or victims of crime. So, in understanding the politics of pressure it is as important to know what kind of issue is in play as it is to know whose issue it is.
But other factors than these need to be taken into account in explaining how and why ‘welfare systems’ do or do not change. For instance, we might have included the contribution of committees of inquiry, the role of significant individuals, the influence of developments in other countries, the impact of the media and modifications in public opinion. No two changes will be accounted for in exactly the same way. In addition, no single factor will offer an adequate explanation. That is to be found in their convergence at particular junctures, but in different combinations, and it is this that makes explanation and generalisation such a complicated matter.
3. Why has the state become the primary provider of welfare services?
This question raises several issues that need disaggregating. First, what is the responsibility of the state and how does the extent of this affect the nature of its involvement? Second, how is this responsibility divided between direct state control and delegation to voluntary and private-for-profit agencies? Thus, a plethora of arrangements is possible, meaning there is no straightforward answer to this question. So much depends upon what period we have in mind, which services and the prevailing ideological assumptions. However, several factors have influenced both the timing and the extent of state involvement in the provision of social services.
Feasibility
States cannot assume responsibilities for providing social services without the means to do so. In that respect two factors are important. First, there has to be an adequate system of administration and this has depended upon the establishment of a competent and sufficiently large civil service. Major reforms occurred in the 1870s that introduced open competition for all departments except the Home Office and the Foreign Office (where posts continued to be filled by patronage for many years). Adequate administrative arrangements have also required a reliable, efficient and properly funded system of local government to which responsibilities could be delegated. This waited upon reforms that addressed the problems of political corruption, great local variation and the multitude of small authorities. Major steps forward occurred in the 1880s; for example, the Local Government Act of 1888 which withdrew almost all their administrative powers from the justices and transferred them to elected bodies – the county councils.
Another necessary condition for the development of public services was the ability of central departments to regulate what went on locally. This relied heavily upon the control that went with Exchequer funding but also upon the creation of various inspectorates, especially in the Local Government Board and the Home Office. The influence that these inspectors were able to exercise depended upon their visits to local areas, the frequency of which was increased by the spread of the railway system. However, some aspects of services are beyond any organisational influence. Foster care is a good example. Governments and local authorities can set regulations, recruit, train and fund carers, but find it difficult to influence what happens in the families.
A further requirement for the development of public services was the creation of an adequate taxation base, both nationally and locally. Nationally, the big step forward followed the establishment of progressive income tax in Lloyd George’s People’s Budget of 1909. Likewise, the income from local taxation (the rates) increased dramatically from the mid-19th century, not least as a result of urbanisation. Access to capital was also important. The development of an international money market and the ability of government to sell its bonds and securities enabled it to embark upon social expenditures that exceeded current revenue. The Public Works Loan Board, first set up in 1817, was also able to expand its activities and became significant in facilitating local authority services, such as workhouses, schools and housing, and other statutory capital schemes like sewerage and drains, by offering attractive interest rates.
Such developments made it possible for governments to assume greater responsibilities for the provision of services, but they were also a response to the problems that had to be dealt with, especially problems of social and economic regulation.
Regulation and control
The involvement of government in the provision of services has owed a good deal to its need to ensure public order and safety. The development of the police and the penal system are obvious examples, but so too are the establishment of a system of compulsory education and the suppression of disease. The spectre of revolution has haunted the corridors of power throughout the 19th and early 20th centuries. The 1926 General Strike in Britain, although brief and defeated, was also significant. Seen in this light, the involvement of the state in the provision of social services has been, at least in part, a necessary concession in order to prevent social disorder or the spread of rampant disease.
The creation and preservation of social capital
Successful states depend upon the creation and maintenance of human capital. In particular, this means having an appropriately sized and skilled labour force which is also healthy enough to do the work required. This has been, and remains, a significant preoccupation of governments. However, what is demanded of a country’s ‘social capital’ changes in response to technological developments and the pattern of economic cycles.
The two main ways in which labour market requirements have shaped public social provisions can be seen in education and health. The need for a compulsory national educational system became obvious and undeniable by the last quarter of the 19th century. Similarly, the unfitness of the workforce and particularly of the future workforce, could not be ignored. Poor maternal health, malnutrition, contaminated water and milk had all taken their toll, as revealed in the 1904 Report of the Committee on Physical Deterioration (HMSO, 1904). Maternity and child welfare clinics began to appear, the infant mortality rate fell (but not until 1923), children were less stunted and more were capable of engaging in school-based physical training.
The rise of legal, political and social rights
It is evident that one of the reasons for the public provision of services is that other systems, principally the market and voluntary agencies, have been either unable or unwilling to do what was required. However, what was required was determined by the gradual establishment of rights consistent with the idea of citizenship, a progression described by TH Marshall in 1950. First came civil rights, then political rights and, finally, social rights – having adequate economic means and welfare as well as being able to live the life of a civilised person according to the standards prevailing in the society. Only when all three existed could full citizenship be enjoyed.
He went on to add that the institutions most closely connected with these aims were the educational system and the social services. Both were essential for the realisation of citizenship and for a more equal society and that, in particular, required taxation and social security systems that aimed to secure the more equal distribution of income, of life chances and social protection, objectives that were only attainable by state interventions.
Although Marshall’s analysis was a creature of its time, his explanation of the close relationship between public social provisions and citizenship was not. What have changed are the assumptions about the kind of services and forms of organisation that are necessary to buttress social rights.
Public responsibility, independent agencies
In returning to the previous discussion of the rapid expansion in the use of the private market to supply health and welfare services, it is important to stress that this is not a renunciation of the state’s responsibility to ensure their availability but simply another way of discharging that responsibility. There have been other reasons why central and local governments have chosen to have welfare services provided indirectly through agents. One has been because the service in question has a small coverage, such as the early industrial schools and reformatories that were established and run by voluntary organisations but almost wholly funded by the Exchequer. A second reason has been the desire to spread responsibility for controversial provisions, particularly those for disparaged and disapproved members of society. It enables governments to support experimental schemes without having to assume full responsibility if they fail.
The politics of comparison
It is tempting to see the development of public services as specific to individual countries. In fact, international comparisons have played their part in persuading governments to extend the range of services for which they are responsible. This is not solely a matter of national pride. It also arises from the desire to strengthen commercial and military potentialities in the light of increasing competition abroad. For example, the British system of social insurance that originated in 1911 was undoubtedly constructed with the German system in mind, a system that seemed to improve production and industrial harmony. However, the 1911 National Insurance Act did not copy the German scheme; it claimed to be better. Furthermore, it could only be introduced by the state (as it had been in Germany) if the British commitment were to be clearly demonstrated. In any case, the contemporary insurance industry was in no position to administer what was wanted and, if they had been, working-class support would have been lost.
There are, however, contrary examples. Where there is a conviction that social provisions are better provided in countries that leave much of it to the private market or the voluntary sector, it will be argued that the role of the state should be limited. A lot therefore depends upon a government’s international reference points.
Betterment
Finally, the preceding comments are liable to give the impression that the state’s close involvement in the provision of welfare services is a matter of unavoidable necessity or political calculation. That would be misleading. There are clear examples where the driving force behind the state development of services has been a genuine desire to better the condition of the people even though that may have been tempered by the considerations we have discussed. Parties, ministers, civil servants and prominent individuals or groups have been motivated by real concerns to improve the ‘welfare of the people’. In some situations, their influence has been significant.
The state becomes involved in the provision of welfare services for a complicated and changing set of reasons. It is hard to generalise, but the rationale springs from a combination of political necessity (economic, social and strategic), the shortcomings of other systems, an adequate administration and an adherence to values that demand social improvement.
Conclusions
In tracing the history of severe and multiple disadvantage, this article has discussed the changing definitions, principles, issues and solutions to the problem. It has particularly stressed the importance of whose definition prevails and why, as this determines the size of the perceived problem and who is eligible for help. As definitions also shape perspectives, the ways that knowledge about disadvantages has accumulated have been discussed.
Looking at the history of services, important factors shaping responses include perceptions of disadvantage, national catastrophes and research findings. In terms of solutions, different approaches have seemed appropriate at different times and we have emphasised the institutional legacy, fragmentation of services, growth of community care, the introduction of universal services, the impact of science and the growth of social markets.
Yet another set of factors had to be identified to explain who gets help and why. Here cost, discretion, co-ordination, the balance of advantage and disadvantage and rootlessness have been suggested as important. A similar array was found with regard to the question of why the state gets involved in some situations and not others; here, wars, feasibility and international comparisons take front place.
The article opened by emphasising that the concept of severe and multiple disadvantage is extremely wide and difficult to grasp, and highlighted the danger of selecting cases to support favoured theories. It has tried to take a broad view and identify the questions that help us understand the historical development of services and disaggregate the dimensions within each one. It is for readers to judge whether it has been successful.