Citizenship and the Politics of Welfare - the case of the NHS
| Published date | 01 July 1998 |
| DOI | 10.1177/095207679801300304 |
| Author | Brian Salter |
| Date | 01 July 1998 |
| Subject Matter | Articles |
Citizenship
and
the
Politics
of
Welfare
-
the
case
of
the
NHS
Brian
Salter
University
of
Kent
Introduction
The
political
relationship
between
citizenship
and
welfare
is
characterised
by
a
dynamic
tension
between
individual
rights
and
state
obligations.
As
fresh
social
rights
are
incorporated
into
British
citizenship,
so
new
demands
are
placed
on
the
political
system.
Yet
the
state's
capacity
to
translate
those
demands
into
new
forms
of
welfare
provision
funded
out
of
general
taxation
has
rarely
expanded
at
the
same
rate
as
citizenship
has
evolved.
And
with
taxation
now
an
established
political
issue,
and
close
to
what
would
seem
to
be
its
electorally
acceptable
limit,
the
imbalance
between
citizen
demand
and
the
available
public
resources
is
likely
to
become
ever
more
acute.
That
the
state
has
found
itself
in
the
position
of
promising
more
to
its
citizens
than
it
can
deliver
is
due
in
part
to
the
political
culture
which
guides
and
constrains
its
actions.
The
hegemony
of
the
values
of
the
welfare
state,
the
requirements
of
democratic
accountability,
and
the
consumerist
emphasis
of
the
political
thinking
of
both
left
and
right
have
restricted
the
state's
ability
to
deny
the
validity
of
its
citizen's
welfare
demands
or
to
succeed
in
significantly
reshaping
those
demands.
Where
the
state
has
had
an
impact
is
in
the
reformu-
lation
of
welfare
supply
and
the
restructuring
of
the
government
machinery
concerned
with
the
funding,
provision
and
regulation
of
welfare
delivery.
In
taking
this
approach,
the
state
has
worked
diligently
with
the
grain
of
the
political
culture
in
order
that
its
authority,
legitimacy
and
citizen
support
should
not
be
jeopardised.
Nonetheless,
for
all
this
activity,
in
the
face
of
the
unremitting
demand
for
welfare
the
state's
central
political
problem
remains
unchanged:
how
to
redefine
its
responsibilities
for
welfare
whilst
retaining
the
support
of
its
citizens.
In
undertaking
what
it
describes
as
'the
first
comprehensive
review
of
the
welfare
state
since
Beveridge'
(Secretary
of
State
for
Social
Security
and
Minister
for
Welfare
Reform
1998,
p.iii),
the
Labour
government
now
confronts
that
problem
directly.
Its
intention,
as
announced
in
the
Green
Paper
New
Public
Policy
and
Administration
Volume
13
No.
3
Autumn
1998
38
ambitions
for
our
country:
a
new
contract
for
welfare
reform,
is
that
by
2020
'there
should
be
in
place
a
new
welfare
contract
between
citizens
of
the
country
and
the
Government'
based
on
a
clear
understanding
of
the
mutual
responsibil-
ities
of
individual
and
state
(ibid,
p.6).
In
analysing
the
dimensions
of
the
problem
with
which
the
government
has
to
deal,
this
article
deals,
first,
with
the
principal
components
of
the
relationship
between
citizenship,
welfare
and
the
state,
their
possible
configurations,
and
their
implications
for
citizen
support
for
the
regime.
Second,
it
examines
how
the
British
political
culture
shapes
that
relationship
through
the
exercise
of
ideological
and
institutional
power
in
ways
which
have
so
far
served
to
compound
the
political
problem.
Third,
it
applies
the
framework
developed
in
the
course of
the
discussion
to
the
National
Health
Service,
now
that
most
politicised
of
welfare
institutions
where
the
collision
between
individual
rights
and
state
duties
is
most
acute.
Citizenship,
welfare
and
the
state
The
utility
of
citizenship
as
a
construct
in
the
political
analysis
of
welfare
is
that,
suitably
refined,
it
can
act
as
the
basic
unit
of
a
framework
which
explores
the
tension
between
the
demand
for,
and
the
supply
of,
welfare
resources.
However,
as
a
prelude
to
developing
that
framework,
it
is
salutory
to
examine
the
misleading
inheritance
of
those
social
policy
commentators
who
have
used
their
view
of
citizenship
as
a
vehicle
for
justifying
and
applauding
the
continued
expansion
of
the
welfare
state,
rather
than
as
a
means
for
understanding
the
political
dynamic
at
work.
In
this
respect,
the
seminal
work
of
Marshall
on
citizenship
has
produced
an
interesting
conceptual
legacy.
In
discussing
citizenship,
Marshall
distinguished
between
the
civil
rights
necessary
for
individual
freedom,
the
political
rights
necessary
in
order
to
partic-
ipate
in
the
exercise
of
political
power,
and
social
rights
which
are
'the
whole
range
from
the
right
to
a
modicum
of
economic
welfare
and
security
to
the
right
to
share
to
the
full
in
the
social
heritage
and
to
live
the
life
of
a
civilised
being
according
to
the
standards
prevailing
in
society'
(Marshall
1950,
p.5).
The
key
difference
between
political
and
civil
rights,
on
the
one
hand,
and
social
rights,
on
the
other,
is
that
realisation
of
the
latter
requires
an
active
and
interventionist
state
prepared
to
give
the
formal
status
of
citizenship
a
material
foundation.
Many
discussions
of
social
rights
agree,
with
Marshall,
that
the
means
used
by
the
state
to
meet
its
obligations
to
its
citizens
should
be
the
welfare
state.
Access
to
state
welfare
services
then
becomes
part
of
the
practical
status
of
citizenship.
If
the
linkage
between
citizenship
and
the
welfare
state
had
been
presented
as
problematic
then
the
road
to
conceptual
development
would
have
remained
open.
Instead,
as
Klein
observes,
both
Titmuss
and
Marshall
'present
the
rise
of
the
welfare
state
everywhere
as
an
inevitable
process:
a
milestone
in
the
progress
of
mankind'
(Klein
1993,
p.8).
Such
a
single-minded
evolutionary
approach
excludes
the
possibility
that
the
citizenship-welfare
relationship
is
contingent
upon
the
socio-political
context,
that
the
welfare
state
in
Britain
is
one
response
to
that
context,
and
that
other
responses
may
emerge
in
the
future.
It
is
nonetheless
an
influential
normative
view
among
contemporary
social
policy
Public
Policy
and
Administration
Volume
13
No.
3
Autumn
1998
39
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