The welfare state is often talked about as a universal safety net, a system designed to catch anyone who falls. But does that image really capture how different countries understand and organise welfare around the world?
In this episode, George Miller talks to Professor Paul Spicker, author of What Is the Welfare State For?, about some of the historical roots, moral foundations, and practical workings of different welfare systems. Drawing on examples ranging from 16th-century Flanders to modern-day India, Paul explores the tension between ideal models and on-the-ground realities – and explains why the British case is far from typical.
The conversation touches on cash assistance, healthcare, solidarity, new technology and the role of the private sector – offering insight into what the welfare state is, what it does, and who it’s really for.
Listen to the podcast here, or on your favourite podcast platform:
Paul Spicker is Emeritus Professor of Public Policy in Robert Gordon University, Aberdeen and a writer and commentator on social policy.
Scroll down for shownotes and transcript.
What Is the Welfare State For? by Paul Spicker is available on Bristol University Press for £8.99 here.
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SHOWNOTES
Timestamps:
00:56 – Can you take us back to the mid-70s and introduce us to who you were then?
06:48 – What is the problem with the ‘ideal’ welfare state?
08:17 – How do you define something as nebulous as the welfare state?
13:31 – Can you tell us about Ypres in Belgium in the 1530s?
24:14 – Why is the welfare state always couched in moral terms?
26:40 – To what extent are those debates healthy and inevitable?
33:30 – Are worries about welfare cuts misplaced?
40:39 – Is the private sector part of the solution or is it actually part of the problem?
43:34 – Is there anything that you’ve fundamentally changed your mind on since the mid-70s?
Transcript:
(Please note this transcript is autogenerated and may have minor inaccuracies.)
George Miller: Hello and welcome to the Transforming Society podcast from Bristol University Press. My name is George Miller and I’m very pleased to have as my guest on this episode Paul Spicker, who is Emeritus Professor at Robert Gordon University in Aberdeen, having previously held the Grampian Chair in Public Policy there.
Paul’s published work includes almost two dozen books and 100 academic papers. His research has included studies related to benefit delivery systems, the care of the elderly, psychiatric patients, housing management and local anti-poverty strategy. He is, in other words, a very qualified person to tackle the question of what the welfare state is for, the subject of his contribution to the What is it for? series.
Before I spoke to Paul, I was looking at his biography, and I saw that back in the 1970s, he started his working life as lettings officer in the borough of Hartlepool in the Department of Housing and Environmental Health.
He writes somewhere that this was in some sense a starting point of interests that he would later to pursue in an academic context.
So I began by asking him to take us back to the mid-70s and introduce us to the young person he was then and the things he was encountering …
Paul Spicker: Yeah, I had drifted into housing as an issue. At school, I had been on a sponsored walk for Shelter. And when I went to university, I thought Shelter, oh, I know something about that. I signed up with the University Shelter Group and started the beginnings of housing aid work, which was about advice and support for people.
When I finished my first degree, I had a brief period of unemployment as things had not worked out as planned. And somebody at the Tyneside Housing Aid Centre suggested that I might be interested in a post that was available in Hartlepool. At that time, council housing was still a very big deal. And Hartlepool being a poor area, it was a still bigger deal. Roughly speaking, the council was responsible for something like half all the houses in the town.
And I was the first graduate that they’d had in the department, apart from the chief executive. This caused some consternation from the local MP, very clearly disapproved of the fact that one of his relatives had not got the post. But I was very much left to my own devices within the constraints, which were considerable. The constraints were that if you start off with a large stock of thousands and a large number of people who have no choice but to go through that system, then you actually have an enormous amount of influence and power. It was something which I had never expected to have, and certainly something which I’ve not seen since. What should have been essentially a junior role became a policy-making role, where I was responsible for the introduction of a points scheme.
And beyond that, was able to change many of the priorities, not all of them. Right at the start, I’d asked somebody in the office on what basis they were allocating houses. And what I was told was, well, this person is rated as good, and that means that they should go to one of the houses that’s rated as good. Now, to give us a sense of what was actually involved in that, people were graded as being very good, good, fair, moderate, poor, or shocking, and they received a house in the appropriate category. that was the starting point.
And I came in with an enthusiasm for trying to deal with people’s needs. I substantially changed the basis. But in fairness, after something in the region of a couple of thousand interviews of people in desperate circumstances, I would say I was pretty much burned out. And when the opportunity came to go on to further study, I went to LSE, where I was able to take a course in social administration, focusing in particular on housing and social security.
And that’s the start of my academic career. Perhaps not the start, because already at that point, I’d studied politics, philosophy, and economics. And the pressure from my parents, I’d studied law, which I had finished part one of the bar examination. But this was the direction that I wanted to move into. I went to LSE with the specific intention of teaching people in the subject. And I’ve retained pretty much the desire to try to get people involved in the study of social policy.
Social policy, however, has changed. But in that time, I mentioned that I was doing courses on housing and social security, because I wanted to be a teacher, also on social work, personal services, health care. A lot of people moved away from the idea that social policy could or should be doing that. And wanted to focus on the issues that they’d learned were important, for example, in sociology, class, race, gender, and thought that it was old-fashioned to look at subjects such as housing or healthcare, and that this was no longer what the subject was about. one of the things which I’ve sought to do in the book is to make a case for social administration that for our people understand that the practicalities of how things are done is still massively important for people’s everyday lives.
GM: I think in the book you discuss the notion of the ideal type of welfare state and say, That can only take you far. And there’s no point in designing it in ideal terms because there has to be a point of delivery. There has to be the reality, grounded in the reality of people’s lives and experiences and needs. So sitting in an ivory tower, as it were, and designing the ideal type of welfare state might be an interesting philosophical exercise, but it’s not actually going to solve many real-world problems, is it?
PS: One of the strange things that’s happened to social policy over the years is that housing has ceased to be a matter that is on the agenda. And having started in housing, I found this really rather strange. But in the book, I refer to a text from the 1970s, which basically said this is fundamental to any welfare state. I share the view that it is massively important. And yet, what happened was that as the bean counters and number crunchers took hold of the subject, they looked at the housing figures and said, but this doesn’t correlate with anything, and started jettisoning considerations of housing in the pursuit of an elegant ideal type, which would be about something else.
GM: And I think that points to an interesting challenge in talking about and writing about the welfare state. If you were writing a book on what universities were for, what prisons were for, what schools were for, it would be somewhat easier. You could actually produce a list and say, well, in the UK, here are the universities or here are the prisons.
When we talk about the welfare state, it seems to me that its parameters and perimeters are quite nebulous. And there may not be a high degree of agreement about what exactly is and isn’t included. And obviously you don’t want to become fixated on definitions and spend half the book on them.
But tell me about that intrinsic challenge of knowing if you’re talking to someone about the welfare state, are you actually both talking about the same thing? How do you reach some level of working agreement that enables any productive dialogue to take place at all, or analysis for that matter?
PS: Well, I’ve started the book with the definition of what the welfare state is, but it isn’t a single definition. The immediate problem we’ve got is that people look at the words ‘welfare state’ and say, ah it’s about the state. If you look at Wikipedia or the Encyclopedia Britannica they will start off by saying a welfare state is a state and almost immediately we have a problem, that is that often welfare state isn’t a state, that throughout many countries, certainly most of Continental Europe, the welfare state is a system in which there will be a large number of non-state actors, some of them independent, some of them set up as, for example, the German system was set up to be as autonomous as possible.
But what I found, and I found this in trying to put forward these ideas on the web – wikipedia allows people to edit and I sought to edit ‘welfare state’ to say the welfare state is not just about the state. Here are three alternative definitions of it. To discover that within a day that this would be obliterated by people on Wikipedia who said, oh no, that’s not right, because it didn’t fit their idea of what the welfare state was. I gave up on Wikipedia sometime ago, I’m afraid.
GM: Is that in part a well-intentioned worry that if the state begins to withdraw from certain areas, it leaves a shortfall which has to be made up for by the third sector? And actually, any admission that the welfare state is not principally about the state is actually letting the barbarians begin to chip away at that edifice. Is there, as I said, a well-intentioned side to that resistance, to seeing it as having other manifestations than the state and its institutions?
PS: I think to take that view that you’d have to be rather better informed than the people who are doing it. Very often people find it difficult to understand that the terms which they have grown up with or learned are used differently by other people.
I have to say that it was something of a shock to the system when I started first to look at social welfare in France to discover just how very different it was and how different the guiding philosophy was. In Britain, the dominant model in many ways was the model put by T.H. Marshall. The idea that we had moved on from political and civil rights through to social rights. That already doesn’t serve as a generalization because there’s a fair number of countries which have gone in the opposite direction, which cannot uplift for rights, but have nevertheless developed welfare systems.
But a lot of the people who are online are looking at it most specifically from a narrow perspective, which is often the perspective of the United States. And in the United States, you will find books which tell you that the welfare state was introduced in the 1930s. And you look at what they did introduce in the 1930s, but hold on a moment. Most countries in the world now do that. And almost immediately we have a difficulty.
(I will say that the welfare state is probably not the most unkindly treated concept. One of the comments that I make in the book is about socialism. The majority of socialists, certainly in European parties, the majority of them are what might be called social democratic and owe very, very little to Marx. Marxism went its own way after the Russian Revolution. The Socialist Party split off. It’s been more than a century, but the dominant political forces, it’s certainly in the European Union, are now the Socialist Parties, not the Communist ones.)
GM: Now Paul, your book is not a history of the welfare state, but you do, at various points in the book, adduce quite telling or interesting contextual examples from history. And we’ve talked a little bit about the 1930s and a lot of people probably think of the welfare state really as getting off the ground after the Second World War.
But I wanted you to take us back to Ypres in Belgium in the 1530s. Because I think it’s just a useful reminder that some of the ideas that we are pursuing today and debating today have antecedents, and really quite interesting antecedents, that go much further back than the post-war settlement. Can you just tell us what was going on in Ypres and why?
PS: It wasn’t alone in that there were a number of cities in the Spanish Empire that had decided that they needed to do something about disorderly welfare. There are all kinds of reasons for this, but generally speaking, beggars and vagabonds and people on the move were considered threatening by the cities. They didn’t want to cut people off altogether from systems of support, but they wanted to distinguish between their people and the others who were coming in and needed some system of control.
There was a great deal of mistrust of the church expressed in terms at the time which were very similar in their way to the comments that the church had made about private and independent charity 700 years beforehand. And as part of what became the Reformation, the cities wanted to claim a certain amount of power.
Now, the scheme in Ypres mirrored pretty much the scheme that was introduced in Mons shortly before that. We’re talking about the time of the Lutheran Reformation – initially slightly ahead, and then slightly behind.
What then happened was that a number of clerics began expressing concern that this was downgrading the Church, and also that it was tainted by the heresy of Lutheranism. What Ypres did that was really unusual was to appeal to religious authorities – in the shape of the academics and judges of the Sorbonne in Paris – and say: “Here’s our scheme. Here’s the detail of it. Here’s how it works. Is this legitimate? Can you confirm that it’s not heretical?”
Well, the Sorbonne did just that. They said, “No, it’s not heretical – and thank you for the cheese.” That sounds like a joke, but it is actually in the correspondence.
What Ypres did was try to put welfare on a firm organisational footing, with proper accountability and controls, to make sure that people in the city would be well treated. And when I say well treated, they had a range of different activities – though the focus was really on the poorest. There was some distribution of money, some distribution of alms. And part of what the city fathers – the Senate – wanted to achieve was a system where they, rather than the church or independent charities, would be in charge of managing welfare.
So you have that moment. And what they did was to go around knocking on doors to ask whether there was anybody in need. They tried to overcome people’s reluctance to depend on social welfare. They were offering education for boys and for girls. They arranged ways in which people could be trained as apprentices so that they wouldn’t be living the disorderly lives that were feared. And in relation to health, they arranged for free medical care, including surgical care. In other words, they had a health service.
And you look at this and think: hold on a moment. This is a report which dates from 1531. It’s an evaluation report based on what they’d been doing since 1525.
Now, by comparison, the British system – which we often think of as the start of national government involvement – actually cuts in primarily in late Tudor times. But the Ypres scheme was influential in lots of ways, and one of those ways was that there’s a 1535 translation into English by William Marshall, who is thought to be responsible for some of the Tudor measures taken in the wake of the dissolution of the monasteries. If you don’t have the monasteries offering charity, who is going to do it?
Now, there’s still very much a punitive element in British legislation from the 1530s, trying to hold back what were seen as the hordes of disorderly beggars. And that’s already pretty late in terms of managing that system. But the Tudor legislation – initially strictly punitive – moves into more involvement until we get to the acts under Elizabeth I. The most important of those are from 1598, with consolidation in 1601.
That becomes the national Poor Law, which involves things like the provision of houses of correction and the setting of the poor on work – one of the expressions of the time. The Poor Law lasts in Britain from 1601 – formally, though actually from 1598 – through to 1948. That’s an extraordinary length of time for a piece of national legislation to remain in place.
In the study of social policy, we’ve tended to focus very much on the British experience, without really acknowledging that the British experience is exceptional. What’s much more typical is the influence that cities had within the Spanish empire and others, where they went for small-scale organisation of charity, with very little being done about the rest.
What happens to the rest is that they’re left to their own devices. And that doesn’t mean they’re left with nothing. There are still private charities, still organisations, still bequests. There are hospitals. And very importantly, there are systems of mutual aid. When people saw a chance to join a guild, or if they belonged to a particular trade or profession, they would do what they could to manage those risks.
And mutual aid becomes one of the most fundamental principles for the development of welfare – not just in continental Europe, but also in America.
The British experience is really quite aberrant and extraordinary by comparison with what’s happening elsewhere. In most places, it’s intermittent, it’s gradual, it’s mutualist. But in Britain, it’s centralised, it’s disciplinary, and it’s focused on the idea that this is about the state exercising control.
GM: And often we think of ourselves as the rule rather than the exception to the rule. And listening to you describe Ypres, I was really struck that debates, you could say debates over ideology, going to the Sorbonne for ratification, Debates about ideology and questions of morality and how they play into policy or the implementation of whatever form of poor relief they were offering. The notion of being reluctant to be dependent, the notion of potential stigma. These are all things which are still with us, aren’t they? Things which you’re describing in the 14th century. We’re still beset with those, some others we’ve added since. But that same set of tensions, of arguments about what the provision of welfare by whichever body will create or potentially create.
PS: Yes. you said 14th century there, and I didn’t actually in this book go back to that. For those who wish to do that, there is an excellent book by Rodman on medieval charities and such of the developments there. But yes, many of the themes are continual that they run through. And the sorts of themes which are important are between the distinction between insiders and outsiders, about what the limits of responsibility are, about the belief that the welfare is not only expensive, but that it’s going to lead to certain sorts of social problems, that you are encouraging the people you don’t want to. it’s rather better than what they’ve had in the 14th century.
GM: True.
PS: Do you want me to run back to, let’s say, a few hundred years?
GM: No, let’s stick with the present. I was really just remarking on the tenacity of certain questions. Maybe we could focus on this question that what the welfare state should be is always couched in moral terms. that seems inescapable, both on the left and on the right. The right will adduce the dangers of dependence and self-reliance, having to restrict the welfare provisions of the state. And on the left, there’ll be a much larger conception of what the state might provide or what the welfare state might consist of. But in both cases, it’s couched in moral terms. It’s not the case that the right abandons that. It’s very much always discussed like that.
PS: You’re absolutely right to say that it will be couched in moral terms – though not necessarily in left–right terms in the way you’ve just framed it, which, again, I’m afraid is a very British perspective.
What happens is that if we actually look at where the political divide falls, it’s different in different countries. And what we find is that in some countries, it’s the hard right that is most militant in favour of support for the poor. The first time I encountered this was in a discussion with a deputy from Mexico, who explained that he’d become a Mexican conservative because he wanted to support the poor.
We have to do a double take in Britain, because that’s just not the way we tend to think through issues of this sort.
But the central point you’re making is indeed right: these are unavoidable moral questions. Some of them are individualist – and that’s played a large part in shaping policy in Britain and America in recent years. Others, however, are collective. And the question becomes: who are we responsible for? Who are we not responsible for? Where do we draw the line? Are we creating effects that we don’t want to create by doing this?
Now, most of those arguments, I think, can be fairly rapidly dismissed. But because they’re moral arguments, they’ll come back regardless.
GM: Yeah. And that must make, well, it seems to me it makes agreement impossible, and therefore we seem to be in this constant push and pull situation where we’re endlessly arguing about the size of the state or the role of the state or who is a justifiable recipient. To what extent are those debates healthy and inevitable? And to what extent do they result in a paralysis and we never actually make any real progress?
PS: Well, they’re certainly unavoidable. I wouldn’t say they’ve led to paralysis, because of what’s been happening. There’s been an explosion of interest in welfare over the last 25 or 30 years, and it’s really quite remarkable how countries of all political colours have suddenly realised that this is part of their responsibility as well.
A lot of that has been expressed through the development of healthcare. A lot of it has also been expressed through the development of education and schooling. These are now, I think, pretty much universally accepted as being part of the responsibility of states – as something that states do.
But something that has developed with remarkable speed recently has been the expansion of cash assistance, with lots of countries discovering that cash is one of the quickest, easiest, and most practical ways of distributing certain services to people – because then they can go and buy what they need. Now, this is clearly controversial in most places where it happens, but it happens in most places. And we’re now talking about, I believe, slightly more than 50 countries which have introduced or developed some form of national cash assistance. That’s pretty remarkable, given that it just wasn’t true 40 years ago.
So yes, it’s a moral issue. But if we then ask, why is it that states of so many different political complexions are doing this regardless? We might, I think, legitimately ask the same question we’d ask of economic policy: why is it that pretty much all states now consider that economic policy is their responsibility? It’s not really that different a question. Simply, this is what states do.
We find that states with – I would say – rather undesirable political views, some of them divided by race or tribalism, some of them determinedly partisan in the way that they use things, some of them seeking to enlist the support of certain factions in their population for authoritarian measures – these states are all engaged in this too.
And if we ask, what is the difference between a democracy which offers welfare benefits to its population and what might be called, in much of the Middle East and North Africa, a ‘social dictatorship’ – a phrase used by Béatrice Hibou – we come to the idea of welfare being used to develop what she calls authoritarian support coalitions. That has become a commonplace.
And the extraordinary thing is that many governments – which we may disapprove of, may mistrust, may be alarmed by – are nevertheless engaged in this kind of activity.
And of course, a definition of the welfare state that’s entirely based on rich Western democracies doesn’t begin to engage with what we actually need to understand about what is going on.
GM: If someone said cynically, That sounds like bread and circuses in quasi-authoritarian states, what would you say to that? Would you say, well, maybe, but maybe that doesn’t matter if human welfare is actually going up a few notches?
PS: Yes, I would say that basically states that are pretending to be more legitimate are doing things that they wouldn’t have done otherwise, and that means that they are more legitimate. We still have a handful of states in the world, really very small numbers, where they would do nothing for the benefit of their population. We’ve seen that in the response, for example, to the tsunami in Southeast Asia. Yes, there are bad actors out there, but with these tiny number of exceptions, what we discover reason it’s much more common that people do what they can in order to shore up their support, to shore up their legitimacy.
And I would argue that insofar as they are acting in ways that make them more legitimate, they are more legitimate. we may have had doubts, for example, about the way that countries like Bangladesh or Jordan are being run, but nevertheless, they are doing a lot, a lot better than the countries such as Myanmar, which are basically not visibly there for the welfare of their populations.
GM: And if they’re doing things for the benefit of their populations, then that probably, as an ancillary effect, encourages transparency, because if they’re doing it, they want it to be known that they’re doing it, therefore they want to spread the word that they’re doing it, that increases, I guess, the potential for the citizenry to participate or to comment and to have a view on it. I can see there is a general pro-democratic direction of travel to that, even if their regime doesn’t want it.
PS: I might just say and argue that actually that a free press is one of the fundamental things for a democracy to develop, but it speaks through this process of making people aware of what is working and what is not working. And we see a fair number of authoritarian governments around the world, which are shoring themselves up on the basis of the welfare services that they’re offering.
GM: Now, Paul, that sounds really quite positive in a lot of ways. But what if we come back to countries such as the UK and several other Western democracies – advanced economies – and think about more than a decade and a half of austerity, the language of austerity, and the worry that what we’re seeing is – I think you use the word cheese-paring in the book – a kind of erosion, a hollowing out from within?
We’ve in some ways retained a lot of the infrastructure, or the superstructure, but we’re losing significant parts of the edifice almost without noticing. The cuts just keep on coming. And it’s not just a question of reducing the size of the welfare state – it feels like it’s actually changing its nature.
Are those worries, do you think, misplaced?
PS: In the book, I pretty much argue that those worries are misplaced. It’s not that I’m in any sense in favour of austerity – it’s that the experience of retrenchment in different countries has shown that welfare services are actually exceedingly difficult to cut.
In the Thatcher era – which goes back rather further than the 15 years you’re focusing on – we find that expenditure actually increased at a time when everyone thought it was being butchered. Certain systems are simply more resistant to being cut. Although some forms of support have disappeared – and I’ve pointed to the move away from housing, which I find incredible – that has, nevertheless, happened.
We’ve also seen remarkable resilience in possibly the least popular forms of welfare, including means-tested benefits. Countries that have cut back on certain types of benefits have nevertheless found themselves constrained to leave some forms of income support in place. That’s been a general pattern. It’s not an inevitable truth, but it’s something that can be charted and seen.
What difference is that making? Well, we’ve seen, as I said, the spread of cash assistance – and a lot of confidence, sometimes misplaced confidence, in the mechanisms that exist to do this. Because it’s actually quite difficult to transfer cash in places where there’s no banking system, where people don’t have fixed addresses.
But we’ve seen remarkable changes. One of the most striking is the development of the Aadhaar card in India – I’m not sure I’m pronouncing that right – which has made it possible for the government to distribute benefits across a vast population. I’ve already mentioned the cash benefits, but I think we should also note something else that’s really remarkable, just in terms of results – and that’s in the field of healthcare: the survival of children.
If we go back to the time when I was starting out, we might have seen figures where three or four children in every ten died. That slowly improved through to the 1990s. But from the 1990s on, we’ve seen a remarkable reduction in infant mortality. And that’s a splendid indication not just of the welfare of children – it’s also about the welfare of the adults who are supporting them, where there are adults.
And basically, that improvement is a real, material improvement – regardless of what we might think of the governments where it’s happened.
GM: You mentioned the Indian card scheme there, Paul. And I guess one of the solutions, perhaps in inverted commas, that’s going to be pushed more and more is technology, and then AI, as a way of solving the problems that individuals and societies face. And it’s completely rewiring the whole structure and relationship between the individual, communities and states. What views do you have on the promise that might or might not hold?
PS: Well, we’ve seen some remarkable changes in technology – though I wouldn’t include AI, which seems to me to be about other things. But let’s point to one extraordinary development: GPS.
What’s remarkable about geographic positioning is – I mentioned the difficulty of dealing with people who have no fixed address. Now, we don’t think of this as a major issue in developed Western societies, where we have addresses and postal systems. We can tell where electricity is being supplied, where water is being supplied, and so forth. But that’s hugely difficult in other contexts.
The advent of the mobile phone in Africa has led to certain forms of social transformation – including, for example, the ability to tell people exactly where you are. And that’s just one element. Mobile phones have also given people a lever against day-to-day corruption. There are lots of things that have actually been happening as a result of technology. That transformation is ongoing.
The development of things like ID cards, certification, proof that a person exists – and the status that goes with that – has made it possible to distribute cash. These are remarkable innovations, and they’re all working through established technology.
Some countries have tried to lead on new technological frontiers – and that’s not always a good idea. Sometimes it’s a dead end. You may end up having to abandon it. I don’t know whether you’re familiar with or remember the French use of Minitel – which seemed like a great idea at the time, a real advance, but rapidly became outdated.
But if we look at some of the other developments and ask: how will they work for people who only have intermittent electricity supplies, who don’t have reliable access to power? Then we’re actually seeing that it is possible to do this. And it has a lot of effects – not just in the field of welfare, but in terms of people’s daily lives.
GM: Where there’s talk of technology, there will be an IT firm trying to sell our government services. And that raises another question I had, which is, do you see the private sector as part of the solution or is it actually part of the problem?
PS: Implicitly, when we talk about the private sector, we tend to mean the commercial, profit-making sector. But I think we need to understand, first of all, that not all non-state firms and organisations are the same.
There’s huge involvement, for example, from mutuals and mutual insurers. The building societies in Britain have taken a battering, and there aren’t as many mutuals as there once were – but they were developed on a mutualist basis, not a profit-making one.
If we then look at some of the other things going on, I’d be very concerned about the development of private equity. That’s not about making profit – it’s about extracting value. And that is quite a different proposition from the question of who carries out which tasks in the distribution of welfare.
I’ve already mentioned cash assistance. Cash assistance relies on a market – that’s the whole point of the cash. If you don’t have some kind of private sector, some kind of system where money can be exchanged for goods, then there’s no real point to cash assistance.
That’s quite different from what happens in healthcare. In healthcare, the important thing is getting care to people, often face-to-face. That involves a certain amount of organisation, which has often not been market-based – though it may or may not involve private providers. But even then, if you ask: who supplies the chairs in the waiting room? It’s not going to be the state. There will always be some forms of procurement.
What you have to do is decide which kinds of systems this approach works for – and which it doesn’t.
There are people out there who claim that everything can be done through profit-making private firms. And I have to say, that seems to me a very limited understanding of what it means to be a non-state actor.
There are many other things that need doing, and that need to be done in particular ways. If we look at most of the changes I’ve mentioned – for example, the improvement in child survival – they haven’t been based on paying people for services. They’ve been based on a different set of principles. And they’ve been very successful.
GM: Paul, we began today with your reflections on you as a young man 50 years ago as a letting officer at the borough of Hartlepool. And I wanted to end by asking you, is there anything that you’ve fundamentally changed your mind on since you were that man in Hartlepool all those years ago? In the sphere of policy, not blue cheese or something like that, something related to your work …
PS: I think the answer is yes, very much so. And I think the most significant impact on my thinking came from learning about welfare in France.
I had come through a system – in Britain – where welfare was considered very much the responsibility of local government, where it was heavily based on the principle of rights, and where the object of the exercise was to realise people’s rights and potential to the greatest possible degree.
In France, I found a completely different logic. There was no single expression that summed up what the welfare state was. Instead, the French relied on a very different concept: the idea of solidarity.
Now, solidarity in the French sense doesn’t mean what we often take it to mean in English – which is more about showing unity or expressing support. In France, solidarity means being part of a network of people offering mutual, practical support. To show solidarity is to give that support.
The way the French framed their system – and this has often confused British observers – was to say: look how well we’re doing, 90% of the population is covered by mutuelles (mutual support organisations). And in Britain, we’d instinctively ask: what about the other 10%? Because we’ve always approached this as a universal, rights-based system.
In France, it wasn’t seen that way. It was understood instead as a diverse patchwork of reinforcing networks. People might belong to many networks at the same time – but some people would inevitably be excluded.
From France, we also get the concept – again, not originally from academic studies – of exclusion. What exclusion meant was being shut out of these mutually supportive networks of solidarity. It’s a completely different model, a completely different way of understanding welfare – but one that nevertheless provided a very high standard of healthcare.
It offered, I think, a rather more patchy standard of minimal support. They had something like seven minima in France, rather than one universal minimum. Still, it offered an alternative way of dealing with welfare distribution – and in effect became the model for Europe.
There was a period – particularly during the presidency of Jacques Delors at the European Commission – when it looked as though the EU might lean heavily towards the French model. That moment has passed, and I regret that. But it clearly had a large influence on countries including Italy, Spain, and Belgium. And I think it also helps us to better understand what’s really going on in some of the most admired systems in places like Denmark or Sweden.
GM: That’s a really interesting thought to go out on, the virtue of shifting your perspective, of seeing how other countries do it. And I think your book is full of that new perspective or insight, which will jolt people out of perhaps their rather fixed views based on the on the United Kingdom and the United States. thank you very much for talking to us this morning.
PS: Thank you.