Over recent days I have been writing about the paradox of entitlement: In general, state-backed social entitlements are the mark of a good society and should be defended, but the impact and financial viability of such rights are problematic if we see and treat them as mere entitlements rather than as part of a broader social contract.
Over the next few posts I want to sketch out some of the ways this paradox might be addressed. I start today by examining aspects of entitlement conditionality. I ask readers to be patient as this is very much work in progress.
The answer to assumed entitlement most often seized upon by commentators and politicians (as well as some leading experts on welfare regimes, such as Lawrence Mead is increased conditionality, particularly in reference to welfare benefits. Superficially this may seen like a right of centre position but, in fact, conditionality has been advocated by some of those most responsible for making the case for expanding social entitlement, including both William Beveridge and TH Marshall. Conditionality is also an accepted part of the relatively generous welfare regimes in countries such as Sweden.
It may be part of a more general tendency to portray welfare recipients as free riding, but I suspect most people underestimate the conditionality already in the system. DWP statistics suggest the current annual number of welfare sanctions is in the region of one million (nearly 200,000 per quarter are sanctioned on Jobseekers Allowance alone). This means a million people a year having their already very low benefit cut for a significant period, usually for failing to attend an interview or not demonstrating sufficient intent in searching for a job.
Indeed if there is an issue around welfare conditionality it may now be that the system now has too many sticks and not enough carrots. Not only have recent cuts in tax credits damaged work incentives, but the Work Programme – like all payment by results welfare to work schemes - tends to channel most support to claimants who are reasonably employable and simply to park those who need much greater support.
In contrast to the benefits system, conditionality in public services is patchy and inconsistent. From time to time there are discussions about not treating patients who refuse to alter their health-damaging lifestyle, and there are last resort sanctions for parents who fail to get their children to school. Refuse collection is an example of a service which has grown to involve a much more explicit and demanding set of behaviours from service users (around recycling), but, overall, the idea that public services involve commitments from both service users as well as service providers runs against the consumerist rhetoric adopted by successive Governments.
These things we know: The most important determinant of a child’s progress at school is parental engagement; our lifestyle and willingness to follow medical advice is crucial to our health; good neighbourliness and social responsibility are essential if hard pressed police time is to be focussed on serious crimes. Yet the simple insight that public service outcomes are the result not of a consumerist transaction but a reciprocal relationship has still failed to penetrate the bureaucratic/professional culture that shapes predominant models of service delivery.
There would be some very difficult issues raised by the idea of denying people core services. But, despite the kneejerk authoritarianism of the English establishment, changing norms and expectations does not have to rely on punishment. I was, for example, very much in favour of the suggestion made a couple of days ago by the NHS Futures Forum that health professional see every interaction with a patient as an opportunity to ask and give advice about lifestyle. As well as the specific value of the advice given this would mean a continual reinforcement of the idea that good health is generally a lot more to do with how we choose to live as individuals and a society than the treatment we are allocated.
Conditionality is one aspect of a more reciprocal model of service entitlement, another is the much diminished contributory principle. I will explore that idea in a future post.
Finally, happy new year to all my reader.
Rachel Sharpe FRSA Michelle Cook
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